HomeMy WebLinkAboutApplicationGørfield County
,l
Com munity Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
'ü j'tìli.t i. ,i.,
c 0 M r,{ t J N ir y L} L. \ r L t. r., r) i* i :l Pi7 ol I 45 -82L2
www. ga rf ie ld-co u Ltv. co m
TYPE OF CONSTRUCNON
INVOTVED PARTIES
DemCom mercia l/M u lti-Family
Manufactured Home (Sinsle or Multi-Level)lAt
V Îesidential (SF, Duplex orTownhome)Reroof
Accessory Dwelling Unit (ADU) - MAXIMUM SIZE OF 1,200 SQUARE FEET
Property Owner:
Mailing Address:TO
Email Address:
Contractor:
Mailing Address:CD
Phone:LaV]ç
Ð LO
Phone:(910 | æq- bqll
D
L7
L
Emait Addresr, fü/¿A,LÞ VV\Ó nb\"^,i ulwl
Architect:N]Phone: I
Mailing Address:
Email Address:
Engineer:t\)Phone: ( )
Mailing Address:
Email Address:
Manufactured Home lnstaller:Phone: (
Mailing Addfess:
Email Address:
PROJECT DETAILS
Describe Work:lnø
tú o STV,rcf v rz..txt-- t 'co( l(-
¿*Thi
I o f"clc\ e,n b¿c. l>rdLæ
çJÖ
¡Þb
Address:
Assesso/s Parcel Number:l4qblqt t+0ll
Sub.lot Btock W{<W\V
oÒo Property Size (Sq. Ft. or Acres):
#oÍFloors: 7
Addition
?6r/Le^lÞ+4ZqOwner's Valuation of Work:
Sq. Ft. of Building:
"Lq4Class of Work:
Garage:ttached
He
el/Alteration
Detached
Driveway
Permit:
i PROJECT DEÍA¡LS CONTI NUET}
, Septic:Community
Type of Heat ral Gas Propane Electric Other
mpt Permit #
NOTICE
Authoritv. This application for a Building Permit must be signed by the Owner of the property, described above,
oranauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedby
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 Permít, (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.
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 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 Building Division. ln
consideration of the issuance of the Building Permit, 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 Regulation(s)). All County development requiring a permit, except for
residential uses, are subject to Article 7 of the Land Use and Development Code. 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 w¡th 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.
I 7z.zoTZ>
Property Owner Print and Sign Date
ìcl"OFFICIAT USE ONtY
Special Conditions:
Manu. Home Fee:Misc. Fees:Adjusted Valuation:Plan Check Fee:iärä".",o
Total Fees:,,^rC)
t ôo:-
Setbacks:
'i#',oo Balance Due:
Const. TypeOCC Group:'þis
OWTS No:
BUITDING / PTANNING DIVISION :
Signed Approval
K'P3"1
Date
¿