HomeMy WebLinkAboutApplicationGuffield County
>r:Fur
ll ;'i
=Ë5 :'ri ãü
"ul ':' 0 q*l¡t r J:tu 1r. ¡¡ L,M, i; tr=' ;. ú.=
ıã
ßu I tÞ rñ (, ¡û,e"
Demolition
Reroof
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970194s-82t2
www.ga rfi el d-cou ntv.com
OF CONSTRUCTION
Commercial/M ulti-Familv
Manufactured Home (Single or Multi-Level)
Residential , Duplex or Townhome)
Accessory Dwelling Unit (ADU) - MAXIMUM SIZE OF 1,000 SQUARE FEET
BUILDING PERMIT
APPLICATION
¡NVOLVED PARTIES
Property Owner:
Mailing Address:
Email Address:
Contractor:
Mailing Address:
Email Address:
Architect:
ne L r2
Wn",
04tl
Phone: I )
Mailing Address:
EmailAddress:
Engineer:Phone: ( )
Mailing Address
Email Address:
Manufactured Home lnstallen Phone:
Mailíng Addressr
Email Address:
I
, PROJECT DETAILS
Describe Work:
Job Address:
Assessor's Parcel Number: 2
Sub
Owner's Valuation of Work:
5q. Ft. of Buildi
Class of Work:
r
l¿
Lot
Height
)
Block
Property Size (Sq. Ft. or Acres):
# of Floors
New ition
Garage:
n8:
Attached
odel/Alteration
Detached
t?,
PROJECT DETAI[S CONTINUED
Type of Heat:
Septic:Community
Electric
Permit #:
Propane Other
Driveway
Permit:
NOTIC.E
¡utñoi¡tv. ThisãþplicatiónforaBuildingPermitmustbesignecl irytheowrreroftheproperty,clescrihecl ahove,
oranauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedby
the Owner, must be provided with this Application.
LeCAIAççeS! A Building Permit cannot be issued without proof of legal and adequate access to the property for
purposes of inspections by the Buììding Dìvision.
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 ¡nformatlon contained above is true and correct. I
understand that the Building Division accepts the Application, along with the plans and specifications and other
data subrnitted by me or oÌr my behalf (submittals), based uporì ¡lìy cerl"ifical"ion 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, lagree 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 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, engineer 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.
/-zs--ze
Property Owner Print and Sign Date
Natural Gas
Fxempt
oFFtctArusEoNry pflþ f¡¡¿.ro c.,c, ætl¿zlz-ozz _á¿..)
Special Conditions:
Adjusted Valuation:Plan Check Fee:Permit Fee:f (00.ôD
Manu. Home Feet{/r Misc. Fees
Total Fees:Fees Paid:
* loo.oa
Balance Due;4g BP No;
ßoor -1rltz OWTS No;
NIA
Setbacks:OCC Group:Const. Type:
l. fiL.c.
Zoning:
P.V. D,
oq/zl¿ozz
Date
BUITDING / PLANNING DIVISION
Signed