HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 81' Street, Suite 401
NOV 0 3 2062 lenwood Springs, CO 81601
[970)945-8212
Gla�i'r=` l_u C www.garfield-county.com
W114= In' TV n
TYPE OF CONSTRUCTION
❑ Commercial/Multi-Family ❑ Demolition
11. Manufactured Home (Single or Multi -Level)
Residential (SF, Duplex or Townhome) ❑ Reroof
INVOLVED PARTIES
Property owner: 4 pu,5 9, [-U c Phone: (ql'b ) 7t -7-44 Z -
Mailing Address: 44ZC ?RAI R 167 t-?AfL- OP W&A-N O OKd S 621il
Email Address: Ail OL)kj AP(D (�,y1Cr st rNir
Contractor:°
Mailing Address:
s1`
Email Address: c* -i� E iLLM,1 -°C A inAt L— ('001
Phone: (470
Architect: Phone: (�j
Mailing Address:
Email Address:
Engineer:
Mailing Address:
Email Address:
Manufactured Home Installer:
Mailing Address:
Phone: ( )
Phone:(_]
Email Address: !
PROJECT NAME AND LOCATION
Describe Work: O-P&Jlt-lli e-r4*AT(--qb a N I- IV # N� R FYI w r4 I- L
�A tdq> i�:707Z— r� Tf �, J �l?�+� �j-�y2
Job Address: i6( SAA Ud0A-6[ �i4t�cam.'"L*cto 1�Z
Assessor's Parcel Number: Z -W; 5016M Sub. iZA-,�" &iZAR114i AP(Lot Block
Owner's Valuation of Work: $ 1000 Property Size (Sq. Ft. or Acres): 0-31 A7(—'
r—
Sq. Ft. of Building: t'�(-0 Height: 1112 # of Floors: 6 1
Class of Work: 11NewJa Alteration ❑Addition 11 Repair . ElMove/Relocation
I
Garage:
Septic:
Type of Heat:
Driveway Permit:
0 -Attached
❑ OWTS
❑ Natural Gas . ❑ Propane
Exempt
❑ Detached
.0 Community
J21 -Electric
I ❑ Permit #:
j ❑ Other
NOTICE _
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.
LegalA_ccess. 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: (1) 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 notcommenced within 180 days of
the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
CERTIFICATION
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 onthe submittals reviewed by the
Building Division. In consideration of the issuance of the Building Permit, I agree that I 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)). 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 County Regulations) or any other applicable 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 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 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 Division do not
constitute an acceptance of responsibility or liability by the County of errors, omissons 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 limitation my architect designer, engineer and/ or
builder.
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as,
have rov'ded the required information which is correct and accurate to the best of my knowledge.
4 c� Ct,4 X1,3
Propertywner Print and Sign Date
OFFICIAL USE ONLY
Special Conditions:
Adjusted Valuation:
Plan Check Fee:
Permit Fee:
Manu home Fee:
Misc Fees:
9�
25. F � I
Fees Paid:
��D. 7�✓
�.
Total Fees:
Balance Due:Br
No:
OWTS No:
to�J' G4
'� • 0D
+3.
Setbacks: e
OCC Group: ��r
Const Type: �� G
Zonin • 1 D
BUILDING / PLANNING DIVISION:
1-2 2
Signed r 1
Date
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