HomeMy WebLinkAboutApplicationGarfield County 1
Community Development Department
to Q 2416 108 Sa' Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.earfietd-county.com
BUILDING PERMIT
APPLICATION
TYPtwOF:CONSTRUCTION• .
Commercial/Mufti-Family
I❑
Demolition
❑ Manufactured Home (Single or Multi -Level)
❑ Residential (SF, Duplex orTownhome) 1 0 Reroof
INVOLVED PAR1'IES7 -.. •
* Property Owner: Rt) PC) L1.0 4 L4'Ne ! u(2t) ,4161Phone:( 970)' -7-4694 ,c
Mailing Address: ).32 WA -12-V-- PI -Vg 1 -B.491-6-7-0 60 g7/6. = 1 n
Email Address: 1-Va -kG-y' d- opi- . reel- &2cPc 'nf /I.,, . $ S £ec.raIaa /'
Contractor: TDIVJ 9Y2 al-LESPhone: ( aj ) 2.61 —02.76(
Mailing Address: e}b .7 JV02uESq , Scc ilk i_ H / ourrargood,e,P i3O/il
Email Address: -C flp,4{6.4-Fr�a o,Yi
Architect:
Matting Address:
Email Address:
Engineer:
Mailing Address:
Email Address:
1/X
Phone:( )
Phone:( )
5.frIT-46(ED
Manufactured Home Installer:
Mailing Address:
Email Address:
Phone:(
PROJECT NAME AND LOCATION
Describe Work: .7-'AJSious-- fi?Aly f', iN'r egarirg ,/ '� SH -OP
Job Address:
Assessor's Parcel Number:. Sub. Lot Block
Owner's Valuation of Work: $ 32.15-00. 00 Property Size (5q. Ft. or Acres):
Sq. Ft. of Building: Height: # of Floors:
Class of Work: ❑New f Alteration r❑ Addition I ❑ Repair El Move/Relocation I
SBE MENr .4410 c�O�,EV , 41Nr t100(f
Garage: ❑Attached 0 Detached
F Septic: 0 OWTS —0—Community
{ Type of Heat: �.@iaturaE Gas I 0 Propane _ 0 Electrici _ _ _ . r ❑ Other
Driveway Permit: I 0 Exempt . 0 Permit #:
I—I
Y-
: 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 may be required: (1J State Electrical Permit, (2) County OWTS Permit, ,
(3) another permit required for use on the property Identified above, e.g. State or County Highway/ Road Access or
a State 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 fora period of 180 days after commencement.
CERTIFICATIONA r; ' :- , h --
I hereby certify that 1 have read this Application and that the information contained above is true and correct. I
understand that the Bui°ding D:visian accepts the Application, along with the plans and specifications and other
j 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
Builaing Division. In consideration of the issuance of the Building Permit, 1 agree that f and my agents will comply
with provisions of any federal, state or local law regulating the work and the Garfield County Building Code, OWTS
regulations and applicable land use regulations (County Regulation(s)). f 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) i
and faci,ity(ies), described above, are not in compliance with County Regulation(s) or any other applicable law,
I hereby grant permission to the BuiW.ing Division to enter the property, described above, to inspect the work.
further acknowledge that the issuer ce of the Building Permit does not prevent the Building Official from: (1)
• requ'ring the correction of errors in the submittals, if any, discovered after issuance; or (2) stopping construction
or use of the structure(s) or facility(ies) if such is in violation of County Regulation(s) or any other applicable Iaw-
1 Review 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 responsibi ity for compliance with federa;, state and local laws and County Regulations
rest with me and my authorized agents, Int luding without limitation my arch,tect designer, engineer and/ or
builder.
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as,
have provided the required information which is correct and accurate to the best of my knowledge.
r
Prope
/;160—) L C-
OwnerPrint and Sign ty l,_,�
Date
OFFJCIAL-USE ONLY -' ` " :k.
Special Contlftlnns. 7;:i0 &PI -4-0S00-1.141r-FOM ael il
Adjusted Valuation:
i�2,S O . oC)
Plan Check Fee:
�(��{,/, 3
•
Per it
4
Manu home Fee:
Mlsc Fees:
Total F s:
.la
Fees Paid:
3o67.8 ,
Bal ce Due: '-i
2fr . oto
BP No:
OWTS No:
�a - tiSD-
Se back
1 '
OCC Group , Const TT. I)
Zoning: e
BUILDING /
PLANNING DIVISION :
i/ 3D' 2-41
Signedra Iv Date
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