HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 Vh
are
OCA 2 8 Za16 Glenwood Ej ings, CO81641
(970) 945-8212
www.Qaffield-munty.com
BUILDINGPERMI.
IT
APRJGNTO
TYPE OF OONS'TFZIicn ON
Com ercial/Multi-Family Demolition
Manufactured Home (5ngle or Multi -Level)
Pasidential (g, Duplex or Townhome) Fbroof
I WOLVED PARTIES
Property Owner: J�9 ok rA-\�X.
Phone:
M ail i ng Address: C -7M W l NCkff'iS S 0 f l
(bntrador:D.��1.1,r-rS-G
Phone:
Mauling Address:
Architect.
r
Phone: ) 1 bQ9 9 't
Mailing Address: i S S+ t 2 Lr�l %]1 Z
Engineer: 1
Phone: c )6�6
Mailing Address. U3• We C QAmy-\
Manufactured Home Installer: Q /R
Phone: ( �
Mailing Address:
PROJKT NAM EAND LOCATION
Describe Work: VNLUD SQj2A Q�aAcm
e.omJ+lQA-4lLt
Jab Address:
As'sessor's Parcel Number: Y�S�3)Z)@b.
Lot Block
Owner's Valuation of Workm 11R C Z- Property Sze (5q. R. or Ames):
5a. R. of Building: ' � Height:
#of Floors
Oassof Work:
4UNew
bLAteration
I UL lAddition
WFbpair
I W Move/Wocation
Garage:
tached
WDetached
S?ptic
Community
Type of Heat:
W Natural Gas
ffJRopaneI
' Sectric
t1JOther
Driveway Pbrmit:
Exempt
I WPL-rmit #:
ac,V\f*6�en, ee ncO C,Sa ; n a � . L6kA
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.
Legal Access` A Building Permit cannot be issued without proof of legal and adequate access to the property for
purposes of inspections by the Building Division.
Other Permits Multiple separate permits maybe required: (1) Sate Sectrical Permit, (2) County OJUTSPermit,
(3) another permit required for use on the property identified above, e.g. Sate or County Hghway/ Fbad Access or
a Elate Wastewater Discharge Permit,
Void Permit. A Building 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.
r"
I hereby certify that I have read this Application and that the information contained above is true and correct. I
understand that the Building Division accepts the Application, along with the plans and specifications and other
data submitted by me or on my behalf (submittals), based upon my certification as to accuracy. Assuming
completeness of the submittals and approval of this 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
Building Division. In consideration of the issuance of the Building Permit, I agree that I and my agentswill comply
with provisions of any federal, state or local law regulating the work and the Garfield County Building Gbde, ONTS
regulations and applicable land use regulations (County Fegulation(s)). I 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 Obunty Regulation(s) or any other applicable law.
I hereby grant permission to the Building Division to enter the property, described above, to inspect thework. I
further acknowledge that the issuaneeof the Building Permit doesnot prevent the Building Official from: (1)
requiring the correction of errors in the submittals, if any, discovered after issuance, or (2) stopping construction
or use of the structure(s) or fadlity(ies) if such is in violation of Qunty Fegulation(s) or any other applicable law.
Feview of this Application, including submittals, and inspections of the work by the Building Division 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 PeWlations
rest with me and my authorized agents, including without limitation my architect designer, engineer and/or
builder.
I hereby acknowledge that I have read and understand the Notice and GBrtification above, aswell as,
have provided the required information which isoorrect and accurateto the best of my knowledge.
�c
Property Owner Print and Sign
OM(IAL UM OILY
— -
,93edal (bnditions:
Adjusted Valuation:
415
Plan Check Fee:
Permit Fee:
Manu home Fee:
Misc Fees:
000.00
1
251.25
---
.�
TO al Fees:
Fees Paid.
Balance Due:
BPNo
OhIVT5N
4414.x&
3, 3
�51.'��
,4
---
Setbacla
OOCGroup:
const Type-
Zoreing-
FX,-',fe25 Slp
V
Fvb
BUILDING/ BANNING DIVISONJ : P�a*(t
'n 1 &
Sgnedpr al
Date
r -10 -¢ Ili 3.NO eco, 10lu11(o
Garftrlcl Cattttrr
BufldinvJ Zoning ]Plan Review Checklist
Permit Number: VLliO - 10 - j{v-4414 o
Building
/ Engineered Foundation
N Driveway Permit
J Surveyed Site Plan
N/A
Septic Permit and Setbacks
f
Grade/ Topography 30%
/
Attach Residential Plan Review List
N�
Subdivision Plat litotes
P�A
Fire Department Review
Valuation Determination/ Fees
/
Red Line Plans/ Stamps/ Sticker
Attach Conditions
/ Application Signed
/ Plan Reviewer to pA
Sign Application
Parcel/ Schedule No.
40#Snowtoad Letter—Manu. Homes
Soils Report
Planning/ Zonin
Property trine Setbacks
30 ft. Stream Setbacks
Flood Plain
Building Height
/ Zoning Sign -Off
Road impact Fees
Grade/ Topography 40%
Planning Issues
N/ASubdivision Plat
General Comments:
Sra-�e op DAek- 1-20 -+ r oe
VOLI"'(*00 : 0/51000. PAN- A19iol' .