HomeMy WebLinkAboutApplicationREC
Garfield County
Community Development Department
JUL 2 8 2017 108 8th Street, Suite 401
Glenwood Springs, CO 81601
C,Al?R:_L ! (970) 945-8212
)MMiiNi t'1 (F -11`"I_ i;' r . www.garfield-countv.com
TYPE OF CONSTRUCTION
❑ Commercial/Multi-Family
❑ Manufactured Home (Single or Multi -Level)
❑ Residential (SF, Duplex or Townhome)
!'"
El Demolition
❑ Reroof
INVOLVED PARTIES j
Property Owner: S �
V\ N '`_ Phone: (1 -i 1 Q 5- ` // [}� 0
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Mailing Address: \,,,)•\1'0‘.,u 1 Ca.
{ b� ke . W
Email Address: rL1Cr 1Y1 f i 1 , CO/Y.\
Contractor: (DV-) Phone:( I j� 3� p
Mailing Address:
Email Address: 1 �� �- [' } o p r ` ' /� y
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Architect: — ( ravd.Phone: (411:2) Coi b--7Madeg L.J
Mailing Address: 1 It) L
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Email Address: (� �'n ti� r r1
Engineer: 1A-6 13 ` '' Phone: { f 1 ) 3 ~ + OD
Mailing Address: 3-6 Pfi)Et.i c Lk); 41 ID 12 -
Email
Email Address: Y `Qin UQ SXe H? 1n (Yea ri - c -n
Manufactured Home Installer: Phone: { ]
Mailing Address:
Email Address:
PROJECT DETAILS e�,� 1
Describe Work: \'�T'U04ck.1 }110irj , > cca\ 2 ` 1Q 'rt vnc
Job Address: 3c--)15 l.An 11 O L &_ ff ola Co q(0
Assessor's Parcel Number: 2, "l3) 1 Cn0Q9
Sub. Lot Block
Owner's Valuation of Work: $ Property Size (Sq. Ft. or Acres): `2 c
1
Sq. Ft. of Building: X351 Height: # of Floors: 2 ----
Class
Class of Work: ❑ New Alteration Addition ❑ Repair ❑ Move/Relocation
Los: Q r\; 3 5 beans ► D 1 rzo,v r be) ra•
PROJECT DETAILS CONTINUED
Septic:
Type of Heat:
Driveway Permit:
fOWTS
0 Natural Gas
Exempt
❑ Propane
0 Community
0 Electric Other
['Permit #:
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.
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: (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 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.
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 on the submittals reviewed by
the Building Division. In consideration of the issuance of the Building Permit, 1 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 Regulation(s) 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, omissions 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
1 hereby acknowledge th
he r quired in
pr
ui s -r. _
a e r a . and understand the Notice and Certification above, as well as, have
ti n whi h 's correct and . urate to the • of my knowledge.
11111
Property Owner Print and Sign
2_
Da e
OFFICIAL USE ONLY
Special Conditions:
Adjusted Valuation:
Plan Check Fee:
Permit
Manu home Fee:
Misc Fees:
Total Fees:
Fees Paid:
Balan Due:
BP No:
OWTS No:
Setbacks:
OCC Group:
c tsR,1-1
Const Type:
Zoning:
Tb.+ 2s.00,
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