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Gcz.rfleÍcl Crss¿rz
108 8'h Street, Suite 401, Glernvood Springs, CO 81601
Ph:970-945-82 I 2 Fx:974-384-3440 Inspection Line: 888-868-5306
vi'q"rv. gal'fìeld-countv. com
BUILDING PERI\{IT APPLICATION
STAFF USE ONLY
I Parçel No: (this inhrmation is ø'ailable at the assessors ofrce 970-945-9134)2?nznit+o¡mt\^ Subd./ Exemption:
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Lot No:
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BIock No:'lÞ't.,"tt z
2 .loh Adrlress: (if on nddrcss hns not heen a,sSigned, please prpvide C.R, HI4T or Steet Nnme. & City) nr anrf legaì descnpìionolEq rP I t0 ê\rn wi,l S?nl-q1. ¿a ( //oi
3 Ow4er: çroperty ownet) ,thitAç lltncø l,z
Maiiins Adåress:u -
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Ph:AIt Ph:
Mailins Address: /
-7ti r Þ t20 fi,r( .?tlal4Contrâctor:lÌva rt 7vr'z7L/->+2.2-Ph:Ait Ph:
5 Manúfactured home irlStalle¡:Mailing Address:Ph:Lic#:
6 A¡chitect:Mailing Address:Ph:AIt Ph:
7 Engineer:Mailing Add¡ess Ph:AIt Ph
Sq.Fr.orAcresofLor:¿ .Ç ¡krv fISq. Ft. ofBuild^tt lg06 Height:z7'No. of Floors:
7-
9 Use of Building:
ffi.esidential flCommercial Dother
Class of Work: ._Bg-{<Nl=
üNew lAlteration lAddition Efiì.epair flDemo lMove
l0 Desc¡ibe *o'u'Ra ^ParlF €Nf ènL, q
1l Garage:
"/14 [ Dxu"¡"¿ flDetached htsos [community
\¡Septic:
ÜNat. Gas fllPropane nElectric Dother
Type ofHeat:
t2 Permit:IADriveway
,/1,/
owners'ffT:w':*
NOTICE
Ietter of authorìty, signed by the Ome¡ must be provided with this Application.
LesslAccess. ABuildingPmitcmotbe issuedwitloutproofoflegalædadequteaccesstotbepropertyforpurposesofinspectionsbytheBuildingDepa¡tment.
Couty Highway/ Road Access or a State ìffastewater Dischuge Pemit.
VoidPermiL ABuildingPemitbecomesm¡lludvoidifthe workauthorizedisnotcomencedwithinl80daysofthedateofissmce mdifworkissuspendedorabmdonedforapøiodof180
days after comencement.
CERTIFICATION
md specifications md other clata submitted by me or on my behalf (submittals), based upon my certification æ to accuacy.
the submittals ¡eviewed by the Building Deparbrent.
construction or ue of the structre(s) md facility(ies), described above, re not ir complimce witb Cowty Regulation(s) or my other applicable law.
of Couty Regulation(s) or uy other applicable law.
limitation my uchitect design€r, engineer md./ or builder.
DATE
J
I HEREBY ACKNOWLEDGE I HAVE READ AND T'NDERSTAND THE NOTICE & CERTIFICATION ABOVE:
Special Conditions:
Adjusted V¡luation Plan Check Fee:Permit Fee:
lco,o'
Manu home Fee:Misc Fees:
rv/n
Total Fees oÐ
atDo
Fees Paid:cÞ Balance Due:
eÞ
BP No & Issue Date:
RIJ)F- Loffi ISDS No & Issued Date:
ñ/n
Sefbacks OCC Group Const Type:aZoning:.
BLDG o
TE DÄTE
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