HomeMy WebLinkAboutApplicationGcx7 - Z l 1 c z -m ty I
108 8th Street. Suite 401. Glenwood Springs, CO 81601
P/,:970-945-8212 !: t:970 -384-J440 llrsped ion Lirre:888-868.3306
www.earlield-county.com
BUILDING PERMIT APPLICATION
AUG .' 2012
GAN -LU l,OuNTY
9011 niton ^ Pt M1NIMI!M
1
Parcel No: (iisiN byannorion k available of flu assessors cyfice 970-P45-9/34)
Lot No: Block No: SRhdf Exemption:
2
Joh Address: Wan mIlresr faunj'l been oa.rigao n: ilemeprovideCR. IIII or SlrerI A'ome & City) or 311(1 legal description
26g LarL pi.r A.k1L' (arbotr�.. / C �d1623
3
Owner: (properlyoa'orr)
ICA{ antiCfractzti R(1Ilk0.bove.
/
Mailin •Address:t
Ph:
4176163 t117
Alt Ph:
4
Cc turactoc
} for
lite.
Mailing Address: '[
1l S 7S Waris&c'!'I�3 4
i'll:
3cz'5. 46%1(3 b
Alt Ph:
5
MantuLLclured home installer.
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Mailing Address: rt?A*
LO
PIF:
Lit #:
6
Architect: N/it
V
Mailing Address:
Ph:
Ali Ph:
7
meet:
SC..7t t As5oc g..ie )IAmt
�y
Mailin Address: A 6 haven l
1 Zl s U is 14.1 ii se. -3&„
Ph: p / q�
f 70,'-‘,590 V
Alt Ph:
X
0
Sq. Fi. of [luil<It 3-°11 *
Sq. Fi. or Acres5' ofLot: �ceor
d r
rlIci II:/ - j%
3 a-s sr
No. ofFirs:
�i
9
Use of Building:
giResidential ❑Conmiercial ❑Other
Class of Work:
❑Neon ❑Alteration ❑Addition lepair ❑Deno ❑Move
10
Describe Work: rottALVk on Revia.t r `^/t {? Inn ` 3 cn S-kIA-CAwce
1 1
Garage:
'\trached ❑Deiacltcd
Septic:
DISDS ❑Community
Type of Ilea!:
'' L fat. Gas ❑Propane ❑Electric ❑Other
12
Driveway Permit: 1 '4
A./14
Owners valuation of Work: ! 0 �?
) t
NOTICE
Aulhorin. This application for a Building Permit roust be signed by the Owner of the property. described above, or an authorized agent. If ere signature below is not that of the Owner, asepal-ale
leiter of aultlority, signed by the Owner. must be prasidcd with this Application.
Lena' Access, A Building Permit cannot be issued without proof of legal and adequate access to the property for purposes of inspections by the Building fepammertl.
Other Permits. Multiple separate permits may be required: (1) State P,Iccnical Permit, (2) County ISDS Permit. ()) another permit rcquiroi for use on the propeny identified above. e.g. SlaIc or
County I tighwayl Road Access ora State Wastewater Discharge Permit.
Vold Permit. A Building Permit becomes null and said lithe work authorized k not commenced within Igo days oldie date of issuance and if work is suspended or abandoned fora period of 180
days after conmaencentem.
CERTIFICATION
1 hereby certify that 1 have read this Application and that the information contained above is true and coned. I understand that the Building Department accepts the Application. along with the plans
and specifications and other data submitted by me nr on my behalf (submittals), bared upon my certification as to accuracy.
Assuming completeness of the subrnituls and approval of this Application, a Building Permit will be issued granting permission to mss, as Owner. to cunsooci the sltucturc(si and facilities detaikd on
the submittals reviewed by the Building Dcparsment.
M consideration of the itittanee of the Building Permit, I agree 11181 I and my agents will comply with provisions of any federal, slate or local law regulating the wart( and rlte Garfield County Building
Code, ISDS regulations and applicable land use regulations (County Regnlation(s)). I acknowledge That the Building Permit may be suspended or revoked. upon notice from the County, if the location.
construction or use of the structure(%) and faciliry(ics). described ribose, arc 301 in compliance with County Regulation(s) or any other applicable law.
I hereby grant permission to the Building Dcpanment to enter the property, described above, to inspect the work. 1 further acknowledge that the issuance attic Building Pemsit does not prevent the
Building Official front (1)fermi? the COIrcetionofertarsi1 Iltcsubmittals,ifany,discoveredofterissuance.or(2)stoppingconstructionoruscnfthestrwrurw(s)urfaei(ity(ics)ifsuchisinsialatian
of County Regulation(%) -y of applicable law•.
Review ofchis Apptic on, includi . submittals. and inspections of the work by the Building fkpartmcm do not constitute an acceptance ofrespmtsibititynr liahiiity by the County of errors, omissions
or discrepancies, the Owner. 1 cknowledge that responsibi ' „ .Iiancc with federal, state and local laws and County Regulations rest with me and my authorized agents, including without
limitation my ar Meet design engineer and" or buihkr,.
1IiEREBY .'NOM.' I:TIIATIHAVE REA!) DL 'DERST '1)TBENOTICE &CI TIFICA'f NAIIOVE:
O% SI N, TUILE. DAT
STAFF USE ONLY
Speciai Conditions:
Adjusted Valuation:
/5-0t Obo.
Plan Check 1O
/c0.
Permit Fee:
I873.75'
Manu home Fee:
,—
Misc Fees:
lo al 'ccs _
I�t5
Fccs Paid:
/%3-1,I75
Balance Due:
—�--
BP Ni) & Issue Date:
ISMS No & issued Date:l
157
3 j
Setbacks:
OCC Group.
Const Type:
Zoning:
BLDG DEP
PLNC DEPT:
, APPROVA DATE
APPROVAL DATE