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Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
l970l94s-8212
www.Ra rfield-countv.com
Garfield County
BUILDING PERMIT
APPLICATION
TYPE OF CONSTRUCTION
Commercial/M u lti-Familv Demolition
Manufactured Home (Single or Multi-Level)
Residential (SF, Duplex or Townhome)Reroof
Accessorv Dwelline Unit (ADU)- MAXIMUM SIZE OF 1,000 SQUARE FEET
INVOTVED PARTIES
Property Owner:Dft\\ GRUË I Phone:rg70 ì311 - bWà
Mailing Address:P. C. ßAK Iq f C wffiftLT-,CC tsrb?(
Email Address:NRÑ .} ßRÜ €IJ€'çJ-D-T. CC y(
Contractor:g Êl4L Phone:
Mailing Address:
Email Addressr
Arch¡tect:q Fme Phone: ( I
Mailing Address:
Email Address:
Engineer:Rfì KC Lr-)sK( - yl l¿¿FeÞ Phone:9'rc:9b3-q642
Mailing Address:Zt? \iJlGUÉ€c ßÐ (Ê RBONDÊIÉ " CC A 1643
Email Address:ftLuiril à 3e?9t5, tJ-É;r
Manufactured Home lnstaller:\r /â Phone: ( )
Mailins Address:
Email Addressl
PROJECT DETAITS
Describe Work:c'oJüq-i-RUCTTC¡J C)tr ñÉ"|J 5. F R ur /Ê-i-rnc+rer:
JobAddress: ?lq 3 € DStuÇ cÊgTÊe-cc 8tb+7
Assessor's parcetNumb
"r, 2l'79 I Z+ A l OÔ'3
Sub.RIIJÉR UI€tlJ R -zLot -) Block
Owner's Valuation of Work: S I ß1, 677. ê+Propeq"rty Size (Sq. Ft. or Acres):
Sq. Ft. of Building:| , b't3 Height:?+'#of
ôrc
Class of Work:X New Remodel/Alteration Addition
Garage Attached Detached
PROJECT DETAI[S CONTINUED
Community
xempt Permit #
NOTICE
Authoriw. This application for a Building Permit must be signed by the Owner of the property, described above,
oranauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedby
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 acknowledge that I have read and understa the Notice and Certification above, as well as, have
provided the required information whiçL[g to the best of my knowledge.
Dftù GR'J[ñ Çf€uT +lulz.
Septic:
Electric OtherNatural Gas PropaneType of Heat:
KDriveway
Permit:
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. 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 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 const¡tute 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
er, e and/ or builder
oFFICIALUSEONLY ?atO, ü q6c,u. ct<,ê qcoa ott/o c/zoz"¿yæ
Special Conditions:eea#aúá uNÞtTa/l/S
Adiusted Valuation:,
thv- LTzbr "lËå:tü',.iTÜ,ÈL,,U Manu. Home Fee:
N/*
Misc. Fees:furçg>þtvZ:
"'[,]ûi6z.su Fees Paid:
47tot".zc 'îiii'åË""u BP No:
BL߀ .1'IZL OWTS No:
se? T-11121
Setbácks:ÔK OCC Group:RE,
Const. Type:
lrLq ÉVRAL
Zoning:
,l-zb-z
BUttDING / PIANNING DIVISION :
Signed Approval Date
Property Owner Print and Sign Date
Ø
Gørfield County
BUILDING DEPARTMENT
108 Eighth Street, Suite 407, Glenwood Spr¡ngs, CO 87607
Tel: (970) 945-8272
PLAN REVI E W CHECKLIST
Permit No: ÊtRtr*¿4-ZZ- 742b
Building lssues Planning/Zoning lssues K
Engineered Foundationexayl*
Driveway Pérmit
Surveyed Site Plany69 4-7427
Septic Permit añd Setbacks
N/ft
Fird Department Review
Property Line Setbacks
30 ft. Stream Setbacks
Grade/ Topography 30%
Attach Residential Plan Review List
Subdivision Plat Notes
ØAlÀtoodPrain
ØlVÞ
./
Yry*fd
Road rmpact Fees 7gS S, Ê,>
Building Height
Zoning Sign-Off
Grade/ lopography 4O%
Planning lssues
Subdivision PlatValuation Determination/ Fees
Red Line Plans/ Stamps/ Sticker
Attach Conditions
7ô5oto -
Descript ion & Summarv:Application Signed
Plan Reviewer to Sign APPlication
Parcel/schedule No.
*oN#"ad Letter- Manu. Homes
soils Report 0A-
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