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Attached
12 Driveway Permit:
108 li" Street. Suite -101, Glenwood Springs, CO 81601
Ph :970-9./5-82 l 2 Fx:970-38./-3-l-IO Inspection Line:888-868-5306
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APR 1 7 ZOlZ
GARFIELD COUNTY
I ~ AN NING
SubdJ Exemption:
Height: /
IZ ..J
Class of Work:
Other New Al!eration
Type of Heat:
ISDS Community Nol Gas
Owners valuation of Work:
NOTICE
e
Alt Ph:
Alt Ph:
No. of Floors:
~
Repair Demo Move
Electric Other
4B1luuiD:. This application fi>r a Building Permit nisl be sipcd by tbc Owner of the property, dllScribad ebo.e_ or en aulhorizal 118""1. I ftbc signature below is not that of the Owner, a ICplll'lllC
letto:r ofautbority, 1iped by the Owia, must be provided with this Application.
Im! t\scps. A Building Pcnnit cannot be issued wilhout proof of lcpl and edcquatc ecccss to the propcny for purposes of inspc:ctions by the Building Department.
Qthfr P,nnlb. Mulliplc sqmniic permits may be n:quin:d ; (I) State ElcQriQ! Paniit, (2) County ISDS Pcrmit, (3) another permit rcquiral for usc on the propcny idcoti6cd abo.e_ e.g. Salle or
COIDlty Highway/ Road Acccu or a State Westcwalcr Disdwge Permit.
Vold Psrm!L A Building Pamit ba:om null end wid if the work eulhoriUICI is aol commenced within 180 days of the dale ofisswuu:c and if work is suspended or abandoned for a period of 180
days after c:ommcnccmcnt.
CERTIFICATION
I hm:by certify that I hive mid this Application lllld that tbc infonr.Uon contained above is true end comet. I undc:rsmd ti.I the Building Oepartmcnt 8"CplJ the Application, along with tbc plans
end spcci6cations llllCI other dala submitlcd by me or on my bcbalf(submittals). t.scd upon my a:rtir1e111ion es to 8'Q1111cy.
Asswnlng coq>leldll!SI of the submittals and approval oftbis Application. a Building Permit will be issued pnting pcm!ISSion to me. as Owner, to conslnlct the structun:(s) and fitcililics detailed on
the submittals Mvicwed by the Bwlding DcpmlJnr:nt.
In considcnrion oftbc ~of the Building Permit, I egrm that I and my agents will comply with provisions of any fcdcral, slalc or loc.I law n:guleting the work end the Garfield County Building
Code, ISOS n:gulalions and applicable land usc n:gulations (County Rcgulation(s)), I acknowlcdgc that the Building Pcrmit may be suspended or revoked, upon nocice lium the County, if the location,
construclion or use oftbc Slnldun:(s) and facilil)'(ios). desc:nbcd abo.e. en: not in compliencc with County Rcgulalion(1) or any other applicable law.
I hadiy gran1 permission to tbc Building Dcpmuncnl to enter the property, dcscnl>cd abo.e. to inspect lhc work. I fw1hcr acknowledge: that the issuance of the Building l'cnnit docs not pineal the
Building Official limn: (I) requiring the comlCrion of mun in the submittals, ihny, discoven:d after issuance; or (2) stopping consuuclion or use of the slnlctun:(s) or lilcilil){ics) ifsuch is in violation
of County Regulalion(s) or any olhc:r applicable law.
Rnicw oflhis App\ic.:ation, including submittals, 1111<1 inspections of the wori< by the Building ~I do not constituk: an acccpmncc of n:sponsibility or liability by the CDWlty of cmin, omissions
or discrepancies. As the Owner, I acknuwlc:dgc: tlw n:sponsibility for _,.,liancc with fcdcral, slalc and local laws and County Regulations rest with me and my authorized "8""1S. including without
limitation my archilc<C designer, engineer llldl or builder.
I HEREBY ACKNOWLEDGE TifA T I HA VE READ AND UNDERSTAND THE NOTICE & CERTIFICATION ABOVE;
DATE
STAFF USE ONI.Y
Special Conditions:
Adjusted Valuation: Plan Check Fee: Permit Fee: Manu home Fee:
5 74l . 72. Sf. VI /'2..5.Z.5' -Total Fees: l/8pi:V-1 Balance Due: ~ & Issue.Date:
zo~ .. 6 t:; IZ5:2f :~4+!
Setbacks: I OCCGroup: Const Type:
F 25: /ZZ-5 5-I
D
DATE
Misc Fees: ----ISDS No & Issued Date:
Zoning:
NOTE: If any required information is missing, delays in issuing the permit are to be expected. If
determined by the Building Official that additional information is necessary to review the application
and/or plans for compliance, the application may be placed on hold until the required information is
provided. Work may not proceed without the issuance of a permit.
The building department will collect a Plan Review fee at time of application submittal. The Permit Fee,
as well as any Septic or Road Impact fees will be collected when the permit is issued.
The permit application must be signed by the owner or by a person having written authority from the
owner to act as their representative.
~~j-°knowledg a-ve read~nrlerslBnd, and will abide with the requirements of this
~ //~--4-17--Z.0\Z-
Garfield County Building & Planning
108 8th Street, Suite 401
Glenwood Springs, CO 81601
Phone: 970-945-8212 Fax: 970-384-3470
www .qarfield-county.com