HomeMy WebLinkAboutApplicationGarfuld CountY
community Development Department
108 8th Street, Sulte 401
Glenwood SPrlngs, CO 81601
(970194s€212
www. garfield-countv.com
Contractor:
Maillng Address:
Emall Address:
Archltect;
Malllng Address:
Englneer:
Mailing Address:
Phone: l('âu 772--{(¿l q
Phone:
Phone: ,k¿llZ-l(19Manufactured Home lnstaller:
Malling Address:
ÊmallAddress:
BUILDING PERMIT
APPLICATION
Demolition
Manufactured Home or
I ReroofF, DU or
- MAXTMUM s¡ZE OF 1,200 FEETUnitDwelli
Phone; (ho ) 3 , -4 13q lg
Emall Address:
Property Owner:
Mailing Address:
Assessol's Parcel Numbel:
Sub. lot
-
Block
Describe Work:
ç
Height:
Property
Job Addressl
Owne/s Valuation of Work:
Sq. Ft. of Building;
New odeUAlterationClass of Work:
DetachedAttached ,/Garage:
Septic:Community
Electric OtherType of Heat:Natr¡ral Gas Propane
I lPermtt #:LIDrlvewåy
Permit:MExempt
Authoritv. This application for a Building Permit must be signed by the Owner of the property, described above,
or an authorized agent. lf the signature below is not that of the Owner, a separate letter of authority, signed by
the Owrrer, rnust be provided with this Application.
Lçsal 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 Perm¡t, (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 Stâte Wastewater Discharge Perm¡t.
Void Permit. A Building Permit becomes null and void if the work authorized ¡s 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.
NONCE
lherebycertifythatlhavereadthisApplicationandthattheinformationcontainedaboveistrueandcorrect. I
understand that the Building Division accepts the Applícation, along wíth the plans and specifications and other data
submitted by me or on my behalf {submittals), based upon my certificatíon as to accuracy. Assuming completeness
of the submittals and approval of this Application, a Building Permit will be issued grant¡ng 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 larld use r egulatir.rrrs (County Regulation(s)). All County development requ¡ring 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, construct¡on 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 Build¡ng Permit does not prevent thc Building Official from: (1) requiring
the correction of errors in the submíttals, 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 thís
Application, including submittals, and inspections of the work by the Building Divísion do not constitute an
acceptance of responsibility or liabilíty 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, includíng without limitation my architect designer, engineer and/ or builder.
CERTIF¡CATION
I hereby acknowledge that I have read and understand the Not¡ce and Certification above, as well as, have
provided the required ¡nformation which is correct and accurate to the best of my knowledge.
Property Owner Print Dete
Special Cond¡t¡ons:
Manu. Home Fee:Misc. Fees:
-'
Adjusted Valuation:Fee:Plan CheckLã^ |
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ne¡ffifej Nl\-/\J.
'i'öþ co iäi5' oc BalanceÀ¡e;ff ff-., €-qhl
OWTS No:
Const. Type:zo4fsj,
ï'< I
Setbacks:OCC Group:
tl84-
Signed Approval
I
Date
BUTtDtNG / PIANNtNG DTVTSTON