HomeMy WebLinkAboutApplicationGørfield County
BUILDING PERMIT
APPLICATIONRECEIVED 108 8'h Street, Suite 401
Glenwood Springs, CO 81601
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GARFI E LD COU
c0M CONSTRUCTION
Commercial ulti-Famil
INVOTVED PARTIES
Community Development Department
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Phone 1tProperty Owner:
Mailing Address:
Email Address:
l_l Demolition
E Manufactured Home (Single or Multi-Level
ReroofSFlex or TownhoResidential
llY
a
tt,o-¿l J+rI: ¡.t¡ -oàAAn Q@ C-nEmail Address:
Mailing Address:
Contractor:
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Phone: ( )Architect:
Mailing Address:
Email Address:
Phone: IEngineer:
Mailing Address:
Email Address:
! Alteration ll Rdd¡tion I nepair ll Move/RelocationClass of Work:! tttew
DetachedInttacrreaGarage:
Manufactured Home lnstaller:
PROJECT DETAITS
Phone: (_)
Mailing Address:
Email Address:
¿_Describe Work:
Job Address:
Assessor's Parcel Number:
?)È e 7 î lt /4/¿A<'< ct p- P,'4/¿4tf- ¿ r' 5
Sub. Lot Block
Owner's Valuation of Work: S-Property Size (Sq. Ft. or Acres)
Sq. Ft. of Building:Height:ta #ofFl
PROJECT DETAI[S CONTINUED
OWTS Community
Electric
Exempt Permit #:
NOTICE
Authoritv. This application for a Building Permit must be signed by the Owner of the property, described above,
or an authorized agent. lf 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.
VoidPermit. ABuildingPermitbecomesnull andvoidiftheworkauthorizedisnotcommencedwithinl80days
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 constructthe structure(s) and facilities detailed on the submittals reviewed by
the Building 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
other applicable law.
I hereby grant permission to the Building Division to enter the property, described above, to ¡nspect 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
construct¡on 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 Iocal laws
and County Regulations restwith me and my authorized agents, including without limitation my architect
d ner,and/ or builder
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
provided information which is correct and accurate to the best of my knowledge'
3 -^t-11
Property Print and Sign Date
Septic:
Propane OtherType of Heat:Natural Gas
Driveway Permit:
OFFICIAI USE ONtY Ø
Special Conditions:t v
home Fee:lflManu
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Misc Fees:N\IAPlan Check Fee:l.\ lA '#iü:þAdjusted Valuation:\\ lf\
BP Nol
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OWTS Ño:
ñt-EFees Éâid:
tl lrn ôo '"ryã:eTotal Fees:
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Const Type:T?c,-Zonine:PrbSetbacks:^lrrllì ÍOCC Grouo:lrQo-wBUILDING / PLANNING DIVISION :
Signed Approval