HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-county.com
TYPE OF CONSTRUCTION
❑ Commercial/Multi-Family
❑ Manufactured Home (Single or Multi -Level)
❑ Residential (SF, Duplex or Townhome)
INVOLVED PARTIES
Property Owner: a\ S �1 L"�� } FUYA
Mailing Address: c #, t [ 1
Email Address: C D\'W1 S[1�'1 �1r ��� (< \
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Contractor: f , �1-1 t —?_eht .) Phone: (_ ) �jk`i^'-t(0�
Mailing Address: LA Cc) I tC c,5a
Email Address: P e)— -1-.)._C‘4")
BUILDING PERMIT
APPLICATION
❑ Demolition
Q Reroof
Phone:(-
Architect:
Phone: (
Mailing Address:
Email Address:
Engineer:
Phone:(
Mailing Address:
Email Address:
Manufactured Home Installer:
Mailing Address:
Email Address:
PROJECT DETAILS
Phone:(
)
Describe Work: t.1;4\
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Job Address: 7 1
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Assessor's Parcel Number:
Sub. Lot Block
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Owner's Valuation of Work: $\1 1t -r ---L9, /ow_ Property Size (Sq. Ft. or Acres):
Sq. Ft. of Building: Height: # of Floors:
Class of Work: , EiNew ❑ Alteration ❑ Addition Repair ❑ Move/Relocation
g
Gara e:. DAttached ❑ Detached
PRCpwCT DETAILS CONTINUED
Septic: ❑ OWTS-
Type of Heat: ; ❑ Natural Gas
Driveway Permit: ' u Exempt
0 Propane
El Community
El Electric Other
D 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, I agree that I and my agents will
cf)mply with provisions of any federal, state or local law regulating the work and the Garfield County Building
Cade. 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 builder.
I hereby acknowtedg_e; hat1 have r Id and understand the Notice and Certification above, as well as, have
provided the r9i.dreld formats which is correct and accurate to the best of my knowledge.
(Pr?erry Owner Flint and Sign
OFFICIAL USE ONLY
Date
Special Conditions:
Adjusted Valuation:
Total Fees:
cO —
Setbacks:
Plan Check Fee:
Fees Pald:
OCt Group:
BUILDING / PLANNING DIVISION
Manu home Fee:
Due: BP No:
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Misc Fees:
OWTS No:
Zoning:
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