HomeMy WebLinkAboutApplicationGARFIELD COUNTY BUILDING PERMIT APPLICATION
108 86 Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 1 Fax: 970-384-34701 Inspection Line: 970-384-5003
tivnvw. carftcld-county.com
STAFF USE ONLY
Special Conditions:
Parcel No: (this information is available at the assessors office 970-945-9134)r
2 rZ S - - oma-- 5
2
Job Address: (ifaq address has not been assigned, please provide Cr, Hwy or Street Mame & Ctty) or and legal description
Plan Check Fee:
Permit Fee:
Manu home Fee:
Misc Fees:
3
Lot No: Black No: SubdJ Exemption:
4
9wncr.(properly awner)
Mailing A�dress:
Ph:�vw _ �
1t Ph-
Bfalance Due:
HP No & Issue Date:
� r
Q /
5
Contractor.
Mailing Address:
Ph:
Alt Ph:
ow A_s lZ
Setbacks:
6
Architect/ En incer.
Mailing Address:
Ph:
Alt Ph:
.1
^ 1--f OL-, jk'
BLDG DE •
7
Sq. Ft. of Building:
Sq. Ft. or Acres of Lot:
Height: I
No. of Floors:
DATE
APPROVAL DATE
fV
8
Use of building: G�.Iz IZ
9
Describe Work,
10
Class of Work:
esu o Alteration ❑ Addition
-
11
Garage:
Septic:
o Attached Detached
o ISDS et Communis
I2
Driveway Permit:n
Owners valuation of Work: S®0
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 separate
letter of authority, signed by the Owner, must be provided with this Application.
Leaal Access. A Building Permit cannot be issued without proof of legal and adequate access to the property for pugwses of inspections by the Building Depanmcm.
Other Permits, Multiple separate permits may be required: (1) Sta is Electrical Permit, (2) County ISDS Permit.: (3) another permit required for use on the properly identified above, e.g State or
County Highway/ Road Access err a State Wastewater Discharge Permit
Void Permit. A Building Permit becomes null and void if the work audaorized is not commenced within 180 days of rhe date of issuance and if work is suspended or abandoned for a period of 180
days after commencement.
CERTIFICATION
hereby certify that I have read this Application and that the information contained above is true and correct I understand that the Building Department ncxc(as the Application, along with the plans
and specifications and other data submmed by me or on tory behalf (subminals), based upon my certification as to accuracy.
Assuming completeness of the submittals and approval ofthis 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 Budding Department.
in consideration of the issuance of the Building Permit, I agree that I and my agents will comply with provisions of any federal, state or local law regulating the work and the Garrield County Building
Code, ISDS regulations and applicable land use regulations (County Regulatroufs)). I acknowledge that the Building Permit may be suspended or revoked, upon notice from rhe County, ifthe location,
construction or use of rhe stmeturc(s) and faeility(iesi, described above, arc not in compliance with County Regulations) or any other applicable law.
I hereby grant permission to the Building Department to enter the property, described strove, to inspect the work. 1 funhcr acknowledge that the issuance of the Building Permit does not prevent the
Building Official from (1) requiring the correction of errors in the submittals, if any, discovered after issuanec_ or (2) stopping construction or use of the stmcture(s) or facility(ies) if such is in violation
of County Regulalion(s) or any other applicable law
Review of this Application. including submittals, and inspections of the v otk by the Building tlCiarri rnt do not constitute an acceptance of responsib(lity or liability by the County of errors, omissions
or discrepancies As the Owner- 1 acknowledge that responsibility for compliance with federal, stale and local laws and County Regulations test with me and my authorized agents, including without
lam' roar my architect designer, engineer and/ r builder
U
I I EBY ACKNOWLE F17. THAT 1 HA ' : READ AND NDERSTAND THE NOTICE & CERTIFICATION ABOVE.
y,11 i2G# 1 S Zo l c)
OWM1 'RS SIGNATUItF , D+ATE
STAFF USE ONLY
Special Conditions:
Adjusted Valuation:
Plan Check Fee:
Permit Fee:
Manu home Fee:
Misc Fees:
8-7-:36. o o
i o8-71
16 7. Z5-
I
----
ISDS Fee:
Total Fees: Fees Paid:
Bfalance Due:
HP No & Issue Date:
ISDS No & Issued Date:
Q /
Setbacks:
OCC Group:
9 c
Const Type: 1z G Zoning:
�7
Z .T' zJr ) D
.1
BLDG DE •
PLNG DEPT:
APPROVAL
DATE
APPROVAL DATE