HomeMy WebLinkAboutApplicationGørfield Coun4t
BUILDING PERMIT
APPLICATION
RECEIVED
jUN 14 ?iü1$
c
Community Development Depa rtment
tOB 8ú street, Suite 401
Glenwood SPrings, CO 81601
(9701945-8212
www.sarfi eld-countv.com
E CommerciafMulti-FamilY :
El tvlanufactured Home {Slnglg o¡ Multi-Leve!)
f] Residential (SF, Duplex or Townhome)
Demolition
llrl Reroof
ftot3s,t-l^dtoe9
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I Property Owner:
. Mailing Address:
Phone:
Email Address
Contractor:
Mailing Address:
Email Address:
Architec:Phone:
r Malllng Address:
Email Address:
Engineer:Phone:
Mailing Address: -
Email Addressi
Manufactured Home lnstalle¡: Phone
i
I
t
Malllng Address:
Emall Address: -.
PRO.IECT DETA|IS
Workl
Job Address:
Assessol's Parcel Number:
Sub.lot _- Block --
Owne/s Valuation of Work:Property Size (Sq. Ft. or Acres|: '------
f
oe
t. -,' Sq. rt. of Building:# of Floors:-
ftnepair I tr ,*""¡*èbcation
floetacheo
[ ruew flAlteration E ndd¡tion
l_lAttached
Class of Work:
Garater
Community
Septlc:
Type of Heat:
. DrlvewaY Permit:
OWTS
'l'lNaturalcas I fl etoPtn'
l
flrxè.fi
flet".tti. i flotn.,
I lPermit #:
r{sitcE
Permit must be signed bY the Owner of the property, described above,
Authoritv.This application for a Euilding
or an authorized agent. lf the signature below is not that of the Owner, a separate letter of authority, signed by
if the work authorized is not commenced within 180 days
ndoned for a period of 180 days after commencement'
the Owner, must be provided with this Application'
, Lesal Access. ¡ guilo¡ng peim¡t cannot be issued w¡thout proof of legal and adequate access to the property for
i pwpos"t of inspections by the Building Division'
I Other Pennits. Multiple r"prr"," p"rtit, may be required: (1) State Electrical Perm¡t' (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
o¡ ttt" ¿"t. of issuance and if work is suspended or aba
I hereby certifY that I have read this APP|ìcation and that the info rmation 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 eccuracy. 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 deta iled on the submittals reviewed bY
the Building Division' ln considerati on of the issuance of the Bu¡ld¡ng Permit,I agree that I and mY agents will
comply with prov¡sions of any federal,state or local l¿w 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 herebv 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 preve nt the Bu¡ld¡ng 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
appl icable law, Review of this Application,including submittals,and inspections of the work by the Building
Divisio n do not constitute an acceptance of responsibilitY or liabilitY bY the County of errors, omissions or
i discrepancies. As the owner, I acknowledge that responsibility for compliance with federal, state and local laws
and County Regulations rest with me and my euthorized agents, including withou t limitation mY architect
designer, engineer and/or builder
I hereby acknowledge that I have readandunderstandtheNot¡GeandCertiflcationabove,aswe|las,have
provided the required information which is correct and to the best of mY
DateSign
L
Special Conditions:
MiscFeeFee:o6Fee:Planuat¡on!
BP NO:DröFees00+oô
Const Tvpe::f,RLoccuifrL
(",*BUILDING / P¡-ANNING DlVlSloN
Signed ApProval