HomeMy WebLinkAboutApplicationGARFIELD COUNTY BUILDING PERMIT APPLICATION
108 8h Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 / Fax: 970-384-3470 / Inspection Line: 970-384-5003
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Parcel No: (this information is available at the assessors office 970.945-9134)
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Job Address: (if an address not been assigned, please provide Cr, l lwy or Street Name & City) or and legal description
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Lot Na: Block Na: �ubd 'x�t r R nE` ,te5
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Off- (property ow r)
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Mailing Address:
le7.3 c:r'c __Dr.
Ph:
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Alt Ph;
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bLcJ NE'
Mailing Address: it L(de, (G
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Architect / Engineer:
Mailing Address:
Ph:
Alt Ph:
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Sq. Ft. of Building:5-7
Sq. Ft. or Acres of Loy
Height:
No. of Floors:
8
Use of Building:-
9
Describe Work:
10
Class of Work:
❑ New o Alteration I] Addition
11
Garage:
o Attached Detached
Septic:
f 7 c ISDS o Community
12 Driveway Permit: —r—,..-.41.-;-1,
Owners valuation of Work: S Q
Authority.
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This application for a Building Permit must bc signed by
Idler of authority, signed by the Owner, must bc provided
A Building Permit cannot be issued without pmaf of legd
NOTICE
the Owner of the property, described
with this Application.
and adequate access to the
Wearied Permit. (2) County
Discharge Permit.
authorized is not commenced within
CERTIFICATION
contained above is true and
based upon my ccrtifieation
a Building Permit will be
and my agents will comply with
Rcgulgion(s)) I acknowledge
are not in compliance with
described above, to inspect
if any, discovered after
work by Use Building Department
compliance with federal. stale
NOTICE & CERTIFICATION
DATE
above, or an authorized
property for purposes of inspections
ISDS Permit, (3) another permit
180 days oldie date of
correct. I understand that
as to accuracy.
issued granting permission
provisions of any federal,
that the Building Permit may
County Regulalton(s) or any
the work. I Ruttier acknowledge
issuance; or (2) stopping construction
do not constitute an acceptance
and local laws and County
ABOVE.
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agent. lithe signawre below is not thal oldie Owner, a separate
by the Building Department
required for use on the property identified above, e.g. State or
issuance and if work is suspended or abandon) for a period of 180
the Building Department accepts the Application, along with the plans
to me, as Owner, to construct Use struCIu1 a) and facilities dctailed on
sate or local law regulating the work and the Garfield County Building
be suspended or revoked, upon notice from the County, lithe location.
other app1icablc raw
that the issuance of the Building Permit docs nal prevent the
or use of the suucturcjs) or facility(ies) if such is in violation
of responsibility or liability by Use County ofarars, omissions
Regulations rest with me and my authorized agents, including without
Lewd Areas.
Other Permits. Multiple separate permits may be required: (1) Stale
County highway! Road Access a a State Wastewater
Void Permit, A Building Permit becomes null and void lithe work
days after commencement.
1 hereby certify that 1 have read this Application and that the information
and specifications and other data submittal by me or on my behalf (submittals),
Assuming completeness of the submittals and approval of this Application,
the submittals reviewed by the Building Department
In consideration of the issuance of the Building Permit, 1 ages that 1
Code, ISDS revisions and applicable land use regulations (County
constructionor use of the structures) and facility(ies), described above,
thereby grant permission to the Building Department to enter the property,
Building Official from: (1) rcquinng the correction of errors in the submittals-
of County Regulation(s) or any other applicable law.
Review of this Application, including submittals, and inspections ofthe
or discrepancies. As the Owner, l acknowledge that responsibility for
' limitation my architect designer, engineer and/ or builder.
I HEREBY ACKNOWL '.DGETHAT 111AVG READ AND uNDERSTANDTHti
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OWNS SIGNATURE
STAFF USE ONLY
Special Conditions:
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Adjusted Valuation:
103618.00
Plan Check Fee:
1(26Mi j
Permit Fee:
19-1'. 25
Manu home Fee:
Misc Fees:
ISDS Fee:
Total Fees:
322 . G4
Fees Paid:
124.1f
Balance Due:
1 06-.0.6"--
SP No & Issue Date:
ISDS No & Issued Dale:
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Setbacks:
OCC Group:
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Const Type:
U
PLNG DEPT.
Zoning:
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BLD DEPT:
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APPIi VA
DATE
.fit ,
APPROVA.
DATE
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