HomeMy WebLinkAboutApplicationGørfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970194s-82L2
www.Farfield-countv.com
BUILDING PERMIT
APPLICATION
DemolitionCommercial/Multi-Fam
Manufactured Home (Single or Multi-Level)
heroofResidential (SF, Duplex or Townhome)
Dwelli Unit - MAXIMUM SIZE OF SQUARE FEET
Phone:
EmailAddress:
Property Owner:
Mailing Address:
bd Phone:I (ô
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Phone: I )
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Arch¡tect:
Contractor:
Mailing Address:
Email Address
Mailing Address:
Email Address:
ìPhoneEngineer:
Mailing Address
Email Address:
Phone:Manufactured Home lnstaller:
Mailing Address:
Email Address:
Describe Work:
Ll ì
Lot
a
Height:tr uSÐ rr
Å
Block
Sq. Ft. of Building:
Owner's Valuation of Work:Property Size (Sq. Ft. or Acres):
f of Floors:_
Job Address:
Assessor's Parcel Number:
5ub.
ðClass of Work:New Remodel/Alteration Addition
DetachedGarage:Attached
PROJECf DETAItS CONTINUED
Community
PropaneNaLural Gas
Sept¡c:
Type of Heat:
ptDriveway
Perm¡t:
Other
NOTICE
Elcctric
Permit #:
Author¡W. This application for a Building Permit must
or an authorized agent. lf the signature below is nott
be signed by the Owner ofthe property, described above,
hat of the Owner, a separate letter of authority, signed by
the Owner, must be provided with this Application.
Lesal 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.
Voidpermit. ABuildingPermitbecomesnull andvoidiftheworkauthorizedisnotcommencedwithinlS0days
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 co ntained 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 Build¡ng Division. ln 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 Regulation(s) or any
ï::ffi:Xïll"Jrî,rr,"" to the Buitding Division ro 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 and/ or builder
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
provided the required information which is correct and accurate to the best of my knowledge.,1
? /t,Ì /tr
D,,;T IPropePrint and Sign
OFFIC¡AL USE ONLY
Special Conditions
MManu. Home Fee:
NJ JN
Permit Fee:
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Adjusted Valuation
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Plan Check Fee:
N\IA
BP N6:
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ovVr's Ñor
N\I ABalance Due:
é$,oo60Fees
þt
'Paid:
nr\.
I Éees:
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Tota{-P
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BUILDING / PLANNING DIVISIO
DateSigned
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