HomeMy WebLinkAboutApplicationICYG'p z 1z iy
108 8'r' Street, Suite 401, Glenwood Springs, CO 81601
P1r:970-945-8 12 Fx•970-384-3440 Inspection Line:888-868-5306` T
wwm.garfield-countv.com 4 i` h V
BUILDING PERMIT APPLICATION
Parcel No: ;this information is avadublc w the assessors office 970.945-9134) Lot No:Block No 5uhd./ Exc ti n:
2l-'...+ `"-j6
Job Address: (fun address has nor been assigned, please provide CR /WY or Street Name & City) or ar dJegal description
557f:30- SLa to-c�� cJ
Q finer: (pro er owner) t
ontractor:
Mailing Address:
170 7/a -tq<1;
Alt Ph:
Mailing Address:
Manufactured me installer:
Mailing Address:
Ph:
Alt Ph:
Ph:
Architect: /
AJ
Engineer:
Mailing Address:
Ph:
Lic
Alt Ph:
Mailing Address:
Ph:
Alt Ph:
Sq. Ft. of Building: G
Use of Building:
Residential
Sq. Ft. o Acres of Lot:
rQs
Class of Work:
❑Commercial ❑Other
10
est cel Work:
Height: t
No. Tors:
ONew ❑Alteration ❑Addition ❑Repair ❑Demo ❑Move
\, t j ,r. cc Por -C ;h"} cr o,,z),A
ti
e.n1clr bum
11 Garage:
❑Attached ❑Detached
12 Driveway Permit:
OA,
Septic:
filISDS ❑Community
Type of Heat:
❑Nat. Gas (6Propane ❑Electric 00thcr
Owners valuation of WoI, • -
NOTICE
rlutharitN. This application for a Building Permit must be signed by the Owner ofthc property, described aboveor an authorized agent. lithe signature below is not that r.f the Owner, a separate
letter of authority, signed by the Owner, must be provided with this Application.
Leen' Access, A Building Permit cannot be issued without proof of legal and adequate access to the property for purposes of inspec sons by the Building Department.
Other Peanuts. Multiple separate permits may be required (I) State Electrical Permit. {2) County ISDS Permit. (3) another permit required for use on the property identified above, c g. State or
Eaumy Highway/ Road Access or a State Wastewater Discharge Permit
Void Permit. A Bui'.rJng Permit becomes null and void if the work authorized is not commenced within 180 days of the date of issuance and if work is suspended or abandoned for a period of 180
days after commencement.
CERTIFICATION
1 hereby certify that I have read this Application and that the information contained above is true and correct. 1 understand that the Building Department accepts the Application, along with the plans
and spectfeaoons and other data submitted by me or on my 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 suucturo(s) and facilities detailed on
the submittals reviewed by the Building Department.
In consideration oldie issuance of the Building Permit, 1 agree that 1 and my agents will comply with provisions of any federal state or local law regulating the work and the Garfield County Building
Cade, ISDS regulations and applicable land use regulations (County Regulation(s)). 1 acknowledge that the Building Permit may be 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
I hereby gram permission to the Building Department to enter the propeny, described above.. to inspect the work I further acknowledge that the issuance of the Building Permit does not prevent the
Building Official from. (1) requiring the correction of errors in the submittals, deny. discovered after issuance, or (2) stopping constriction or use of the swsturc(s) or facility{ies) if such is in violation
of County Regulation?s} or any other applicable law
Review of this 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 with federal, state and local laws and County Regulations rest with me and my authorized agents, including without
Iimitanon my architect designer. engineer and/ or builder
I HEREBY ACKNOWLEDGE THAT I HAVE READ AND LNDERSTAND THE NOTICE & CERTIFICATION ABOVE
5:21u3,,L,A
<////
DATE
TA/ rCI' iI `11•��G _
OWNERS SIGNATURE
STAFF USE ONLY
Special Conditions: -
Adjusted Valuation:
35 795, 8 y
Plan Check Fee:
313.4 6
Permit Fee:
98 z • /5
Manu home Fec:
Misc Fees:
Total Fees: S/
// t -5
Fees Paid:
?11
Balance Due:
S 8 'G.J. 7 y
BP No & Issue Date:
ISDS No & Issued Date:
- W 5Z
Setbacks:
OCC Group:
Coast Type:
Zoning:
lig•
BL DE '
�5/ ,
P N D
�f*/
APP OVAL DATE
APPiOVAL DATE