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Architcct:r'l_ _
tTU..l>~AF I
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9 Use ofBuilding:
108 8"' Stretl. Suite .JOI. Glenwood Springs, CO 8 /601
Ph:970-945.S2 J 2 Fx:970·384-3440 lnspeclio11 Li11e:888./168·5306
www.garfield-coun tv .com
BUILDING PERMIT APPLICATION
Mailing Address:
"""' '2.... •
Mailing Address :
Lot No :
/7_
'Or.
Alt Ph :
73
Lie#:
Mailing Address : Ph : Ah Ph:
. S7' !ht#. t1. "'}7() ·;l.'f /-67$2..
Mailing Address :
61 0'-1t
Ph:q 7 () • f:/fJ'/, 2336 Ah Ph:
Height: No. of Floors:
.;;:l.-
Class of Work:
sidcntial Qeommercial OOlhcr _r:AQew DAlleration DAddition ORe air ODcmo OMove
10 Describe Work:
11 · Garage :
DAttachcd ~tachcd e DElectric OOther
12 Driveway Penn it: Owners valuaJion or Work:
NOTICE
d!!.!!!!!.!:!n:· This appliwion fora Building Pcnnit must be signed by the Owner of the property, described above. or an aulhorUcd qenl If the signatun: below is not that of the Owner, a separate
lencr of .uthoricy, sipcd by the Owner, must be provided with this App li cation.
Lepl Arms, A Building Pcnnit cannot be issued wilhout proof oflcpl and lldequate access to the propcny for putpOSeS of inspections by the Building Department.
Other Permits. Mul ti ple sepanlle permits may be n:quired: (I) Slate Elecirical Permit, (2) Councy ISDS Pcnnit, (3) another permit requiml for use on the property identified above, e.g . State ot
Couaty Hipwayl Road Access ot a State Wastcwalcr Disclwiie PcnniL
Vp!d Psrm!L A Bwlding l'mlut becomes nllll and void if the work .uthorizal 11 not commenced within 130 dll)'I of the dale of issuance and if work is suspended or abandoned for a paiod of 180
dll)'I after commencement.
CERTIFICATION
I hereby ccnify thar I hive read this Appliw ion and that the infonnation conlained above is true and corrcrt I undcntand Chat the Building Depanmcnt acccp15 Ilic Appl ication, along wilh the plans
and specificati ons and other data submincd by me or on my behalr (subminals), based upoa my catilication as IO accurncy.
Assuming complctmc:ss of the subminals and •ppmval oFthis Application,• Building Pmnit wi ll be issued grmuing permission to me. as Owner. to c:anstr\ICI the lll'UCftlft{s) and f11eilities dcsailed on
the submin.ls reviewed by lhc Building Department.
In cansidcnrion of the issumcc of the Building Permit, I asrce that I and my agcnu will comply with provisions of any federal. state or IOQJ law rcplatins the work and the Garfield Councy Building
Cocle, ISDS rcplations and •pplicablc land use resulations (County Rcgulation(s)). I aclmowlcdsc lhat the Building Pc:nait may be suspended or revolted, upon notice 1ium the Counry, ifthe location,
1 conslnll:llon or use of lhe ltNCIUtt(•) and &ciliry(ics). described above, an: not ia wmpli1111cc with County Rcgulalion{s) or any other applicable 1-
I h=by JllWll permiuie>n to lhc Bwlding Ocpulmcnt to enter the propcny. dacnDcd above, to inspect lhc work. I funher acknowledge th111 1hc issuance of the Building Pmnit docs not prevent the
Building Official from: (I) n:quiring the comcrion of enon in the subminals, if any, discovc:nd after issuance~ or (2) stopping consuuction or use of the stn1c1t={1) or focility(ics) ir such is in violation
ofCounry Rqrul•tion(s) or any othenpplicablc law.
Review of this Application, !nduding submlnab. and inspcr;cions of the wink by the Buildms Dcpanmcnt do not comaitu.1c an aca!ptana: of responsibility or liabilicy by thc Councy of errors, omissions
or discrcp111cics. As the Owner. I acknowledge thar responsibility for compliani;:c with fcderal , swe aad local laws and Cowuy Regulations rest with me and my authorized agents. including without
1;~~~~~tcc;t dcsi , ginccr and/ or builder.
()':.l._KNO GE ATI R£ADAND UNDERSTAND"" NOTICE& CERTinc•; i~) ?-
OWNE S GNATU DATE l ------------
STAFF USE ONLY
Adjust ed Valuation :
20 5Cf'Z . Q.Q.
Plan Check Fee:
~11.9
Manu home Fee: Misc Fees: Permit Fee:
3~.z.>
Fees Paid:
Ft· q J
TolalFecs:
,55~,/
BP No & Issue Date:
1 (jl/!£-~s'-6
ISDS No & Issued Date: Balance Due:
.,./ 3'$,Y. '2.,J
I
OCCGroup:
J:.JZ-(_
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 person having written authority from the owner
to act as their representative.
Building cannot be occupied until a Certificate of Occupancy (CO) is issued .. Using the building without a
CO will be considered an illegal occupancy and may be grounds for vacating the premises. (Final/CO
inspection requirements will be attached to your approved field set of plans.)
I hereb acknowledge I have read, understand, and will abide by the requirements of this
chec i t
Garfield County Building & Planning
108 8111 Street, Suite 401
Glenwood Springs, CO 81601
Phone: 970-945-8212 Fax: 970-384-3470
www.aarfield-county.com