HomeMy WebLinkAboutApplicationGarfield County
t q )(y. ".Community Development Department
\l 1f. . .,, f?J v1· 1 ~08 8th Street, Suite 401
.J JI (Glenwood Spri ngs, CO 81601
(970) 945-8212
www.garfield-countv.com
1---C_o_mm e~::i;~~1~!~:ily ---_-~---_ -_ ---_.~..__ Demo_lit_io_n __________ ~ Ma n ufac tured Hom e (SF or Dupl ex)
====R-=-e-s_id entia l (SF, Du plex, or Townh-o~m_e_)__ fb Reroof
INVOLVED PART-IE-S --i
Property Owner: ~..--IC\ Y'.£-~ flo~ °::..vJ h b. 5' Phone: ( °17 b ) 3"7 9 t:A q '5;
Mailing Address : JZ l 4 4 Q_~ 3 3_~ L £ ( '$. W 1:J Le 4 (
Contractor: __________________ Phone :( __ -------
Mailing Address:----------------------------
Architect: __________________ Phone:( __ -------
Mailing Address:----------------------------
Engineer: __________________ Phone:( __ -------
Mailing Address :----------------------------
Manufactured Home Installer:-----------Phone:( __ -------
Mailing Address:----------------------------
PROJECT NAME AND LOCATION -// ~ -----:! ~ /
Describe Work: a01U ufJ£ ~· ~ ~
Assessor's Parcel Number: _______ Sub. ________ lot __ Block
Owner's Valuation of Work: $ ____ (_1-41J __ . ------Property Size (Sq .Ft or Acres):-----,
f I'd. l n ! h I Sq.Fto Bu mg: ___ ..... ~ .... "'----Heig t: __ __. __ _
Class of Work: --D New j D Alterat ion I D Additi on D Repair
Garage: D Attac hed D Detac hed
Septic : DISDS 1. D Community
-Type of Heat: D Natural Gas D Prop ane D El ec tric
I
D Oth e r
-
Driveway Permit: D Exe mpt D Pe rm it ##:
[NOTICE
Authority. This application for a Building Permit must be signed by the Owner of the property, described above, or
an authorized agent. If the signature below is not that of the Owner, a se parate letter of authority, signed by the
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Owner, must be provided with this Application.
Legal Access . A Building Permit cannot be is sued without proof of legal and adequate access to the property for
purposes of inspections by the Building Division.
Other Permits. Multiple separate permits may be required : (1) State Electrical Perm i t , (2) County ISDS Permit, (3)
another permit required for use on the property identified above, e.g. State or County Highway/ Road Access or a
State Wa stewater Discharge Permit.
Void Permit. A Building Permit becomes null and void if the work authorized Is not commenced w ithi n 180 days of
the date of iss uance and if work i s suspended or abandoned for a period of 180 days after commencement.
CERTIFICATION
I hereby certify that I have read this Application and that the information contained above is true and correct. I
understand that the Building Division accepts the Application, along with the plans and specifications and other
data submitted by me or on my behalf (submittals), based upon my certification as to accuracy. Assuming
completeness of the submittals and approval of this Application, a Building Permit will be issued granting
permission to me, as Owner, to construct the structure(s) and facilities detailed on the submittals reviewed by the
Build ing Division. In consideration of the issuance of the Building Permit, I agree that I and my agents will co mply
with provisions of any federal, state or local law regulating the work and the Garfield County Building Code, ISDS
regulations and applicable land use regulations (County Regulation(s)). I acknowledge that the Building Permit
may be suspended or revoked, upon notice from the County, if the location, construction or u se of the structure(s)
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and facility(ies), described above, are not in compliance with County Regulation(s) or any other applicable law.
I hereby grant permission to the Building Division to enter the property, described above, to inspect the work. I
further acknowledge that the issuance of the Building Permit does not prevent the Building Official from: (1)
requiring the correction of errors in the submittal s, if any, discovered after iss uance; or (2) stoppi ng construction
or use of the structure(s) or facility(ies) if such is in violation of County Regulat ion(s) or any other applicable law.
Review of this Application, including submittals, and inspections of the work by the Building Divisi on do not
constitute an acceptance of responsibility or liability by the County of e rrors, omissions or discrepan cies. As the
Owner, I acknowledge that respon sibility for compliance with federal, state and local laws and County Regulations
rest with me and my authorized agents, including without limitation my architect designer, e ngineer and/ or
builder.
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
hav°1vlded the required Information hich is correct and accurate to the best of my knowledge .
{f 6 l t7 -:2"l-1~
Date
OFFICIAL USE ONLY
Special Conditions:
Adjusted Valuation: Plan Check Fee: Manu home Fee: Misc Fees:
~ ~
Total Fees: 60 Fees Paid: Balance Due: ~:
1:>!).'S.-:Jr;.~~ ~ 60
Setbacks: OCCGroup: Const Type:
BUILDING I PLANNING DIVISION: &-J. .A IJ.iun~
Signed Approval
~:
Zoning:
Date