HomeMy WebLinkAboutApplicationGørfield County
BurçptÞt6d
çFì' -¿'¡- ul
11 g=
Ë ¡'; süö :i.i 3H!J,J ,\- l¡lhN, ;'!-, tr g
':i!.. É,=
ıã
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
l970l94s-8212
www. garfl eld-cou ntv.com
OF CONSTRUCTION
Manufactured Home (Single or Multi-Level)
Residential (SF, Duplex or Townhome
Acc Dwell Unit U) - MAXIMUM SIZE OF I,OOO SQUARE FEET
Demolition
Reroof
BUILDING PERMIT
APPLICATION
I
INVOTVED PARTIES
Property Owner:
Mailing Address
Email Address:
Phone
Mn",2{"
h 1
0t
Contractor:
Mailing ad¿ress,1 0Ò
Email Address:
Architect:Phone: ( )
Mailing Address
Email Address:
Engineer:Phone: ( )
Mailing Address:
Email Address: _
Manufactured Home lnstaller:Phone:
Mailing Address:
Email Address:
PROJECT DETAITS
Describe
Job Address:
Assessor's Parcel Number:
Sub.Block _
Owner's Valuaticn of Work:Property Size (Sq. Ft. or Acres)
Sq. Ft. of Building:Height:
Class of Work:New
Lot
Detached
dition
Garage Attached
Remodel/Alteration
# of Floors:--
1
; PROJECT DETAITS CONTINUED
Type of Heat:Natural Gas
Septic:
I
I
I
I
I
I
I
Community
l
Propane Electric
Pèrmit #:
Other
Driveway
Permit:
NOTICE
Authoritv. ThisapplicationforaBuildingPermitmustbesignedbytheOwneroftheproperty,describedabove,
oranauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedby
the Owner, must be provided with tlris Application.
Leeal 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 Disclrarge Perrlit.
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 certÌfy 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 Applicat¡on, a Building Permlt will be issued grarrtirrg
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, lagree that land my agents will
comply with provisions of any federal, state or local law regulatirrg tlre work and the Garfield County Buildirrg
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, descrlbed äbove, 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 lssuance; 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
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.
/.-2ç*aez
Print and Sign Date
[-lExempt
oFFlclA[USEONIY PAID Jtoo.¡¡ c.c. èrlz1/2âzZ éi"r*
Special Conditions:
Adjusted Valuation Plan Check Fee:Permit Fee:I loo. oo Manu. Home Fee:
ru/r
Misc. Fees:
Total Fees:Fees Paidl
.f, loo. oo
Balance Due:rg BP No:
Roor -717?
OWTS No:
¡,t/l
Setbacks:OCC Group:Const. Type:
t, R.. c.
Zoning:
?.v,D,
o,lln fzoz¿
Date
BUILDING / PTANNING DIVISION :