HomeMy WebLinkAboutApplicationce; GarfieldCounty
Community Development Department
108 8111 Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfleld-countv.com
Pcrna!ition )
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i Contractor: ~1-\;,,i"t..i t..'t ~).•1dX tL.,,,;, ., ... 4 I Malling Address: .Z.'1 ~-i tl '> rt.-.'( 6 f. '>L· (:· ,1. Ad\ tL·> .. k . i L ~. l v :-. i~ 'l. :;-
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Ardlltec:t: _________________ Phone:(_), ______ _
1 MalllngAddress: __________________________ _
,___ _______________ ·----------------·
I Engineer. __________________ Phone: (__) ______ _
Malling Address: ___________________________
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I Manufactured Home lnmller: ___________ Phone:(.__ _ _, ______ _
Malling Address: __________________________ _
1 Describe Work : k'Cf!);>~~ e;\ ..,,.,,,...._.~ MO,t..,;,~ i!N:.1w? ~ ff;,-tM t'M 2 . ~tt: _
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; ?-+. ,M '• ..:o,.-''° r •'\t • ~ ~-"l •• ' , • c_,.,t:I ~ J ~.&..:1 •~1rl i i f § 1
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I JobAddress: .~c; ?t/.\r... tJ;>._·.t:..T 1 ~c\;...:..4 .-Lc (~ ~/(-,1./'j • '.
I z. I L r-., , 1-1 c; ~· ,.,.. r A 1 "v .,., ' S' , Assessor's Parcel Number: ..} ., b '-1° i <-'ll. Sub . s 1.1 A I) u , u :i Lot~ Block __ i
l Own r' V 1 t" f W rk: $ f ~ ~ • P rty Si (S Ft A e s a ua IORD 0 . -·.# 4 rope 12e q. or . aes ! I
Sq.Ft of Building: l 4~" ~ Height: /')'I # ofRoors! I I ! /
Class of Work: El New I a Alteration I [J Addition I a Repair I 0 Move/Relocation I
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I Garage: D Attached D Detached
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Septic: OOWTS I S"'Communlty
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--TVPe of Heat: C3'Natural Gas ! D Propane I D Electric 0 Other
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Driveway Pennlt: lJ Exempt I D Permit#: I
Autl!orttv. This application for a Bulldlns Pennit must be sisned 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 Appllcatlon.
I ~I Access. A Building Permit can not be Issued without proof of legal and adequate access to the property for
l purposes of inspections by the Building Division . 1
Other Permits. Multiple separate permits may be required : (1) State Electrical Permit, (2) County OWT5 Permit , I
' (3) another permit required for use on the property identified above, e.g. State or County Hlshwav/ Road Accez or r
I a State Wastewater Discharge Permit. j
1 Vold Pllm!lt. A Bulldlng Permit becomes null and voi d if th e won: authorized Is not commenced within 180 da~·s of ,
the date of iSStJance and If work Is suspended or abandoned for a period of 180 days after commencement. j
l hereby certify that I have read this Appllcation and that the Information contained above is true and correct. I
understand that the Bulldlng Division accepts the Appllcatfon, along with the plans and specifications and other
data submitted by me or on my behalf (submittals), based upon my certification as tc accuracy. AssurrJns
completeness of the submittals and approval of this Application, a Building Perm it will be Issued granting
permission .to me, as Owner, to construct the structure(s) and facilities detailed on the submittals reviewed by the
Building Division . In consideration of the issuance of the Building Perm it, I agree that I and my agents will comply
with provisions of any federal, state or local law regulati ng the work and the Garfield Coumy Building Code, OWTS
reuulatlons and applicable land use regulations (County Regulation(s)J . I adcnowledge that the Building Permit
may be suspended or revolced, upon notice from the County , If the location, construction or use of the structure(s )
and fadllty(les}, desalbed above, an! not In compliance with C.Ounty Regulatlon(s) or any other appllcable law .
I hereby grant permission to the Building Division to enter the property, described above, to Inspect the work. I
further acknowledge that the Issuance of the Building Permit does not prevent the Bulldlng Official from: (1)
requiring the correction of errors In the submltta!s, If any, discovered after Issuance; or (2) stopping construction
o r use of the structure{s) or fadlity(les) If such is In vio lation of County Regulatlon(s) or any other applicable law.
Review of this Application, lndudlng submlttals, and Inspections of the worl< by the Building Division do not
constitute an acceptance of responsibility o r llabllity by the Counly of errors, omissions or discrepancies. As the?
Owner, I acknowledge that responslblllty for comp liance w ith federal, state and local laws and County Regulations
rest with me and mv authorized agents, Includ ing without limitation trr( architect designer, engin eer and/ or
builder.
I hereby acknowledge that 1 have read and undemand the Notice and Certification above as well as
have provided the required lnfonnation which is co~ and accurate to the best of my knowledge.
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Property OWner Print and Slgn Date
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Adjusted Valuation:
2000 -
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Teal Fees: gf:i 25.
Setblds:
M II
7'~6 pd 25 ar:-
°'ec}t..-# I 09 2-
Plan Chedl Fee: -
25:~
OCCGrgup:
Permit Fee: ¢ Manu home Fee:
ZS·
Misc Fees:
l!!.!2: QW!'SNo:
£~c. Cunst Type: -/2 ...? c..