HomeMy WebLinkAboutApplicationC`CA a /y 1 ��
1088t Street, Suite 401, Glenwood Springs, CO 81601 9
PIt:970-9.15-8212 F.r:970-381-3440 Inspection Line:888-868-5306 TAN
ww v.garfleld-countv.com
44
BUILDING PERMIT APPLICATION , eo
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Lot No: Block N9: Suba.i Exem 4:400302
oh Address: (Ifat) uddreh. hu. nese beets tt,tgorr d. please p mute C'k. NB's' ur tirreei Nmne et (}(r) or and legal description (;
"3k 606y4Gfr�sA. ccorciG C. BArr1em«7- Akar .$A
Total Fres:
24 t,. z r
Owner: (properly titter)
D is N -¢414.4.4s
Mailing Address:
34o 0►44d s4 et 0,c1.z
Ph:
3443 •• 3 av • c>?7
Alt Ph:
}
Contractor: —.
(.Lo. f#I'AT. talo,/
Mailing Address:
Po 13er'x 1 5. 2
Ph:
lsa.c-11n54,
Alt Ph: -
'Leg- /44-7
5
Manufactured home installer:
Mailing Address:
Ph:
Lic 4:
6
Architect:
Mailing Address:
Ph:
Alt Ph:
7
Engineer:
Mailing Address:
Ph:
Alt Ph:
8
Sq. Ft. of Building:?
6
Sq. Ft. or Acres of Lot:
7�$
Height:
No. of Floors:
A.
9
Use of Building:
riResidential ❑Cotmnercial ❑Other
i Class of Work:
❑New ®Alteration ❑Addition ❑Repair ❑Deniu DMove
10
Describe Work: r
T 'Pot 5/.4 13104eb.E.cir
1 I
Garage:
!$Attached ❑Detached
Septic:
DISDS V3Community
Type of Heat:
111 4al. Gas '❑Propane ❑Electric ❑Other
1?
Driveway Pennit:
Owners valuation of Work: ,4.
- NOTICE
Authority, This application fora Building Pennit must be signed by dee Orvner of the properly. described above, or an authorized agent lithe signature below is not that of the Owner, a separate
leiter of authority. signed by the Owner. must be provided with this Application.
Legal .-access. A Building Pennit samtot be issued without proof of legal and adequate access to the property for purposes of inspections by the Building Department
Other Permits. NIulmple separate perilluIs may be required' 111 Stale Electrical Permit. (2) County ISDS Pennit. (3) another permit required for use on the property identified above. e.g. State or
County l hghway! Road Access or a Stale waste, uirl Discharge Pellitil.
Vold Permit, A Building Pennit becomes null and %aid lithe work authorized is not commenced within 180 days of the date of issuance and if work is suspended or abandoned fora period of 180
days alter commencement.
CERTIFICATION
1 hereby certify that I have read this Application and that the iulimnation contained above is true and correct. I understand that the Building Department accepts the Application. along with the plans
and specifications and other data submitted by me or on my behalf (subinittals), based upon my certification as to accuracy.
Assuming completeness of the submittals and approval of this Application. a Building Persil wilt be issued granting permission to Inc. as Owner. to construct the structure(s) and facilities detailed on
the submittals reviewed by the Building Department
In consideration of the issuance of the Building Pennit. I agree that 1 and my agents will comply with prosisions of any federal. state or local law regulating the work and the Garfield County Budding
Code. ISDS regulations and applicahlc land use regulations )County Regulation(s)). I acknowledge that the Building Pennit may he suspended or revoked. upon notice from the County, if the location.
construction or use of the structure(s) and facility(ies). described above. are not in compliance with County Regulation(s) or any other applicable law.
1 Iseret, grant permission to the Building Department to enter the property. described above, to inspect the work. 1 further acknowledge that the issuance of the Building Pennit does not prevent the
Building Official from: (1) requiring the correction of errors in the submittals. if any. discovered after issuance: or (21 stopping construction or use of the structure(s) or facility(ies) ifsuchis in violation
of Corutt% Regulation's) or any other applicable law.
Rel ten of INS Application_ including submittals. and inspections of the work by the Building Department do not constitute an acceptance of responsibility or liability by the County of errors_ omissions
or discrepancies. As the Owner. I acknowledge that responsibility for compliance ssidr federal. state and local laws and County Regulations rest with the and my authorized agents, including without
luinitau i my architect designer. engineer and/ builder.
1 HEREB 1CKNON'LEDG AT 111A IND UNDERSTAND THE NOTICE & CERTIFICATION ABOVE:
I-22- 2U\2)
OWNERS SIGNATURE e -s-- DATE
IA( �� lam' !.ZS 13 STAFF USE ONLY
5a - 1OO a0533- $3(p3.25
'pedal Cumdilions:
:Adjusted Valuation:
22 /44/e 9Y
Plan Check Fee:
/00 -�'(F 5)
Permit Fee:
363. z,S
Manu home Fee:
-
Mise Fees:
`..---
Total Fres:
24 t,. z r
Fees Paid:
100,
Balance Due:
3 b , z,-
RP No & Issue Date:
ISDS No & Issued Date:
13ZPF ,Ala9
Como
Setbacks:
FL,S� jZz 5/o
OCC Group:
c
Const Type:
r,P.+e✓
Zoning:
Pub
G •
co
131 DF 4PRO\I'
/ Z 3
,� Y f,
APPROVAI. DATE.
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