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Community Development Department
lOB 8th Street, Suite 401
Glenwood Springs, CO 81601
(970194s-82L2
www.garfield-cou ntv.com
7
BUILDING PERMIT
APPLICATION
TYPE OF CONSTRUCTION
DemolitionCom mercial/M u lti-Fami
Manufactured Home or Multi-LevelSi
Rerooflex or TownhomeResidential
Dwelli Unit DU - MAXIMUM SIZE OF SQUARE FEET
INVOTVEÐ PARTIES
Phone:$zÒt<7c3?Í A6S4-/
Email Address:
Property Owner:
Mailing Address:
D&4/'
/e
Phone ê7q z'/Í ô64 )Contractor3
Mailing Address:
Email Address:
Mailing Address:
Email Address:
Phone: (-)Arch¡tect:
*Phone:Engineer:
Mailing Address:
Email Address:
Mailing Address:
-
Email Address:
Phone: (_)Manufactured Home lnstaller
PROJECT DETAITS
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Height:
e
Describe Work:lt ñt¿ c
O 3/
,-G Ç rr<>aAÊ ffi.r n
Job Address:
Assessor's Parcel Number:
Sub.
Property Size (Sq. Ft. or Acres):Owner's Valuation of Work
Sq. Ft. of Building:
Lot
-
Block
-t olìloo¡sz /
AdditionNewRemodel/AlterationClass of Work:
Detached?/ttachedGarage:
PROJECT DETAI[S CONTINUED
CommunitySeptic:
OtherElectricPropaneType of Heat:Natural Gas
Permit #:ptDriveway
Permit:
must be signed by the Owner of the property, described above,
not that of the 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 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.
NOTICE
Author¡tv. This application for a Building Permit
or an authorized agent. lf the signature below is
and that the information contained above is true and correct. I
e 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, lagreethat land 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 compliancewith County Regulation(s) orany
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
applÌcable 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
CERTIFICATION
I hereby certify that I have read this Application
understand that the Building Division accepts th
neer an or builderer,
I hereby acknowledge that I have read and understa nd the Notice and Certification above, as well as, have
provided the required information which is correct and accurate to the best of my knowledge.
6 'zz-
rty Owner Print and Sign Date
usE oNrY ?*tD, s 2!i: oo cK.tt l2+z og -1à'*z
Special Conditions:
Manu. Home Feer¡/¡Misc. FeesP.ermit Fee:
# zr,enPlan Check FeeAdjusted Valuation:
OWTS No:--ñ7¿BP No:
oe¡no-r?¿8
Balance Due:tøFees Paid:i zî,Ò.
Total Fees:
| 25..ô
Zoning:
R,Ufl"AL
Const. Type:
l.l. ê.
Setbacks:OCC Group:l.R.c.
BUILDING / PLANNING DIVISION :
DateSigned
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