HomeMy WebLinkAboutApplication.pdf2 3 4 5 6 GARFIELD COUNTY BUILDING PERMIT APPLICATION 108 8" Street. Suite 401 . Glenwood Springs. Co 81601 Phone: 970·945-82 121 Fax: 970-384-3470 1 Inspection Line: 970·384-5003 www.garfield-county
.com Ph: f.;> .' -U.>'i3 Mailing Address: Ph: Alt Ph; 7 Sq. Ft. or Acres of Lot: Height: No. of Floors: 8 Use of Building: 9 JO Class of Work: aNew o Alteration o Addition I I Garage:
Septic: o Attached o Detach d olSDS o Communit 12 Driveway Pennit: Owners valuation of Work: $ ( I "&6",_ or..> NOTICB Authority, Thls application for a Building Pennit must be signed
by the Owner of the propeny, described above. or an authorized agent. If the signature below is POt thai of the Owner, a separate leller of authority, signed by the Owner, must be provided
with this Application. LeKal A«css, A Building Permit cannot be issued without proof of legal and adequate access to the property for purposes of inspections by the Building Department
Other Permits. Multiple separate penniLS may be required: (I) Suite Electrical Permit, (2) County ISDS Permil, (3) another permit required roruse on the property identified above, e.g.
Stale or County Highway! Road Access or a State Wastewater Discharge Pennil Void PerrniL A Building Pennil 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 11 period of 180 days after commencemenl CERTIFICATION I hereby cenil'y thIll I have read this Application and lhallhl!:
information contained above is true and COl"lttl J undentand thatlhe Building Department accepts the Application, along with the plans and specifications and other data submitted by
me or on my behalf (Jubmiu.als), based upon my certlficatlon as to accUJacy. Assuming completeness of the submiuals and Ilpproval of this Application, a Building Permit will be issued
granting permission to me, as Owner. to construct the struc.ture(s} and facilities detailed on the submittals reviewed by the Building DepartmcoL In consideration of the issuance of
the Building Permit, I agree that I and my agents wi ll comply with provisions of any federal. state or local law regulating the work and the Garfield CounlY Building . Code, 1505 regulations
and applicable land use regulations (County Regulation{s». I acknowledge that the Building PemUt may be suspended or revoked, upon ooti~ from the County, if the location, construction
or use of the structure(s) and facitity{ies). described above, art nol in compliance with County. Regulation(s) or any other applicable law. I hereby grant permission to the Building
DepartrDl!ot to emu the property, described above, to inspect the work. I further acknowledge that the issuance of the Building Permit does not prevenlthe Building Officitll from: (I)
requjring the coRccuon of errors in the submitL"lls. if any. discoveced after issuance; or (2) stopping construction or use ofthc StnlClure(s) or facitity(ics) if such is in violation
of County Regulation(s) or8.(1y other applicable law. Review of this Application, including sUbmilUlls. and inspections or the work by the Building Department do not constitul.e an acceptance
of responsibility or liability by the County of errors, omissions or discrepancies. As the OlVner, I acknowledge that responsibility ror cOf"lllliance with federal, state and local Jaws
and County Regulations rest with me and my authorized agents, including without limitation my . tdesigner, engineer and! or builder. I HEREBY WLEDGE THAT I HAVE READ AND UNDERSTAND THE
NOTICE & CERTIFICATION ABOVE: STAFF USE ONLY /Bf'· \\0 '\ Special Conditions: ~~~0?4 lY1~Y-IDtL -4 .~ ml 72 Quu F. tr..o ,f-7-H,L 1//, Adjusted/,: Plan Check Fee: Permit Fee: Manu home
Fee: Mise Fees: --\Cfj. ------ISDS Fee: Total Fees: Fees Paid: Balance Due: BP No & Issue Date: ISDS No & Issued Date: ~ \(J~ . ,... \00· ....... ,to IReO [--3oYLi Setbacks: OCCGroup:
,'/. Const Type: Zoning: ( . ~ '\ .-. PBLD DE~~£( PLNGDEPT: ~ ?~ //-5-2.08 APP OVAL) DATE APPROVAL DATE