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Comm unlty Development Department
108 8th Street, Sulte 401
Glenwood Sprlngs, CO 81601
(9701 94s-8212
www.sarf¡eld-countv.com
Garfield County
BUILDING PERMIT
APPLICATION
TYPE OF €ONSTßUCTION
Commercial/Multi-Familv Demolition
0¡1-anufactured Home (Slngle or Multi-Level)
t/Residential (SF, Duplex or Townhome)I Reroof
Accessory Dwelllng Unit (ADU)- MAXTMUM SIZË OF 1,000 SqUARE FEET
Email Addressi
Phone¡ Qlat 7q'1-107U
INVOLVED PARTIES
Property Ownet:
Maillng Address:
Phone:Contracton
Mailing Address:
Emall Address:
Archltect: Phone¡
Malllng Address:
Emall Addresss
If
Englneer: Phone:
Mailing Address:
Emall Address:
ìI
Malllng Addtess:
Emall Address:
Descrlbe Work:
Helght¡
Phone:
2qo- ,Èj D?eef
S of Floorsr-
Sub.
PROJECT DETAIIS
Owner's Valuatlon of Work: $
Sq. Ft, of Buildingr
Manufactured Home lnstallen
Assessor's Parcel Number:
Job Address:
5 Btock 3
Property Slze (Sq. Ft. or Acres|:
-
Class of Work:
DetachedGarage:
RemodeUAlterationNew
Attached
Electric
PROJECT DETAITS CONTINUEO
Septic:Community
Type of Heat:Gas Propane Other
Drlveway
Permlt:
NOTICE
Author¡h/. This application for a Building Permit must be signed by the Owner of the property, described above,
or an authorized agent. lfthe signature below is not that ofthe 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 Perm¡ts. 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 Perm¡t.
Vold Permit. A Building Permit becomes null and void if the work author¡zed ¡s notcommenced 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 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 Bullding Division. ln consideration of the issuance of the Building Perm¡t, 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 Regulatíon(sll. I acknowledge that the
Building Permit may be suspended or revoked, upon notice from the County, if the location, construct¡on or use
of the structure(s) and facility(ies), described above, are not in compliance wíth 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 fromr (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 ís in violation of County Regulation(s) or any other
applicable law. Review of this Application, includlng submittals, and ins¡rections 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, t 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
€f,ra or builder.
I hereby acknowledge that I have read and understand the Notlce and Certification above, as well as, have
provided the requlred lnformatlon whlch ls correct and accurate to the best of my knowledge.
< lt /tz
Property Prlnt and Sign Date
l-lExempt
Perm¡t l:
oFFrc'ArusEoNLy ?Ap ftoô.oo c.c, ot/ce/¿a¿-> éfu
Speclal Conditions:
Adjusted Valuatlon:Plan Check Fee:Permlt Fee:{loa.oo Manu, Home Fee:¡t/x Mlsc. Fees¡
Total Fees:Fees Paid:tlao'*Balance Due:nd BP No:
ßôoF- 7?{!t OWTS No¡
-N/rSetbacks¡OCC Grouo:' l.Ê. c.
Con$t. Type:t.È. g Zonlng:
P,ú,Þ.
BUILDING / PTANNING DIVISION :
Slgned Approval Date