HomeMy WebLinkAboutApplicationGarfiefd Cozen
108 th Street, Suite 401, Glenvood Springs, CO 8160/
Ph:970-94 5-82 I 2 Fx: 970-384-3440 Inspection Line: 888-868-5 306
www. garfi eld-county.com
BTIILDING PERMIT ABPLICATION
I Parcel No: (this inþrmation is qvailable at lhe assessors oflice 970-945-91j4)
,9 lzÃ* 4A*ÒÒôln [,otNo:BlockNo:
f) /A.Subd./ Exemption:
2 ^'åäiä' z'ff - þ]'"3 î' g *^z,'.fr:-
:
*lü"Wå'Yä""*ffiï'[ronl
-t Owner: ( nmøertv owner\,n,k>'á'D"L C^i.t s/3 no'-L7ç oiro AItPh:
4
Èrn' >io"'/ôt'?AItPh:) flt- ÀÒ81
5 Mãufactured home installer :Mailing Address:Ph:Lic #:
6 Architect:Mailing Address:Ph:AItPh:
7 Engineer:Mailing Address:Ph:AItPh:
8 sq. Ft. of Buildr*, )áOO É Sq. Ft. or Acres oflot:Height:No. of Floors:
9 Use of Building: " 7
ffi.esidential üCommercial E0ttrer
Class of Work:
ENew flAlteration EAddition flRepair flDcmo EMove
l0 DescrþtÌlo$:'/e,^r ¿ff el|/síþl 1o2t-; -o.L /1Ot5&t rC ab7 t7 t-'tfk /12< /..7 /<<:(t'/ry'el
aøs( f,'/toni-n, I pa/r^¿&- -,¡1/l/l ) 7 a ^^<¿- ¡>fo m^Åa / r>trh-i.
lt Septic:
N DArøched EDeøched nrsDs
4yp'ofHeaf.
N / ۓ [Ttlat. Gas Elhopane EElectric Elother
t2 Drívewav Permit:+xrsnNA
,Owhers valuation of Wo$ ã CCf¡
NOTICE
letter ofauthority, signed by the Owner, must be provided with this Application
Lcsal Access. A Building Permit cannot be issued without proofoflegal and adequate access to the properry for purposes ofinspections by the Building Department.
Cq¡nty Higùway/ Road Acc€ss or a SÎåte Wastewater Discllarge P€rmit"
days after commencement'
.ERTIFICATI.N
and specifications and other data submitted by me or on my behalf(submittals), based upor my certification as to accurasy-
the submittals reviewed by the Building Department.
consfuctioñ or use ofthe sÍucÍure(s) a¡ld facílity(ies), desoibed above, are not in csnpliance with Counry Regulation(s) or any other applicable law.
ofCormty Regulation(s) or any other applicable law.
limitation my architect desigrrer, engineer and/ or builder.
I HEREBY ACKNOIdVLEDGE I{AVEREAD AND UNDERSTAND THE NOTICE & CERTIT'ICATION ABOVE:
DATE
STAFF USE ONLY
Special Conditions:
Valuation:
ôo(
Plan Check Fee:Permit Fee:cx)IOC
Manu home Fee:Misc Fees:
Fees Paid:oolCI)
Balance l)ue:c E[.No & Issuc Dete:
-7PlL
ISDS No & Issued l)ate:
Nfâ
Total Fees:(})
Const Type:TnmingzSetbacks:OCC Group:
DATE
,u.
DATE