HomeMy WebLinkAboutApplicationGørfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970194s-82L2
www. ga rfiel d-cou ntv.com
BUILDING PERMIT
APPLICATION
TYPE OF CONSTRUCNON
Commercial/Multi-Family Demol¡tion
Manufactured Home e or Multi-Level ¡Gas Piping
,Residential (SF, Duplex or Townhome)Reroof
Accessory Dwelling Unit (ADU) - MAXIMUM SIZE OF 1,000 SQUARE FEET
INVOLVED PARTIES
Property Owner:
Mailing Address:
Slefé {r¿z.n,"c-K" phone: t7ão I ê72 -S?9'l
t54l r,z<..,b t4( tsz íMt ê(¿<'"*-4 qao,r"
þuz ZìÅzâ;n*¿?. ( ¿vE)Email Address:
ßrt nfr. Hli** S+sk ^5 phone=ttu | iff-{6roContrector:
Mailing Address: gz¿r./,ax/ ç'.il co x/tsz- 5E€Ê 571-ê735
Email Address:
PROJECT DETAITS
Describe Work:4s +a Z- tvÊ7-e<
o rës. eÐ4 Qr /1 4e lv
Job Address:
Assessoy's Parcel Number:
Sub.Lot Block
Gas Pipe Length/ Diameter:tøtx 'slq' f,w
Appliances Serviced By Gas Line (list all, include BTU):f- f6s,ooc bTq Bü,ler. (^*.o,)*
Class of Work:
Elo,."r.',,on Addition
Type of Heatr ffi,,,,tc,,Propane
NOTICE
Authority. This application for a Building Permit must be signed by the Owner of the property, described above,
or arr authorized agerrt. lf the signature below is 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 acccss to the property for
purposes of inspections by the Building Division.
O_theflefm¡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 W¿¡stewatcr Disclrurge Perrrrit.
V¡ld_PeffnjlJ 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 abandoncd for a pcriod of 180 days after commencement.
lherebycertifythatlhavereadthisApplicationandthattheinformationcontainedaboveistrueandcorrect, 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
cornply witlr provisiorrs of arry 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 lssuance of the Building Permit does not prevent the BuikJirrg Otticial frortr: (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 authorlzed agents, lncluding 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 requi which is correct and accurate to the best of my knowledge.
Property Owner Print and Sign Date
OFFICIAL USE ON[Y \
Special €onditions:
Adjusted Valuation:
N/A
Permit Fee:\CfrAO Misc. Fees:
BP No:
WÍ)E-Blt"s ton'P__'iää c)o Fees Paid\cô.c)ct Balance Duc:e-
BUILDING / PLANNING
Date
¡1 -^ulÅb- //e
Signed Approval
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