HomeMy WebLinkAboutApplicationGarfield Courtty
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
ls7ol94s-82L2
www.ga rfieldcountvco.sov
TYPE OF.CON5TRUCTION
Commercial/M u lti-Family Demolition
Manufactured Home or Tiny Home (Single or Multi-Level)
Residential (5F, Duplcx or Townhome)I Reroof
Accessory Dwelling Unit (ADU)- MAXIMUM SIZE OF 1,200 SqUARE FEET
INVOLVED PARTIES
U*oo SPhone:
Email Address
L Cc-s
Property Owner:
Mailing Address:
\Phone
C),J}C
Contractor:
Mailing Address:
Email Address:
Architect: Phone:
Mailing Address:
Email Addressl
PhoneEngineer:
Mailing Address
Email Address:
Phone: ( )
Email Address:
Manufactured Home lnstaller:
Mailing Address
PROJECT DETA!LS
Sub. [ot
-
Block
ofWork: S I ?-,.5a O': . Propertysize(sq.'Ft.orAcres):
Describe Work
UA
Height;# of Floors:_
Assessol's Parcel Number
Job Address:
Owner's Valuation
Sq. Ft. of Building:
New Remodel/AltqrationClass of Work:Addition
Garage Attached Detached
PROJECT DETAILS CONTINUED
I hereby acknowledge that I have read and understand the Notice and Certification ahove, as well as, have
provided the required information which accu to the best of my knowledge.
r - /* /*s'
Property Owner Print and n Date
Septic:fWTS Community
Natural Gas Propane Electric OtherType of Heat
Driveway
Permit:
Exempt 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.
Lesal 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 Hiehway/ 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 oi issuance and it work is suspended or abandoned for a period of 180 days after commencement.
qERilFt-c.$frtoN:
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
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consideration of the issuance of the Building Permit, I egree 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 with 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.
OFFICIAT USE ONLY
Speclal Conditions:
Adjusted Valuationl Plan Check Fee:Permit Fee:\oc) ,o s Manu. Home Fee:Misc, Fees:
Total Fees:\oo9c,Fees Paid:
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Balance Due:&BP No:
[.mFq<At
OWTS No:
Setbacks occ GrouD:Gil-!Const. Tvoe:
E{?J1 .
zoniE
BUTTDTNG / PLANNING Dtvtst
Signed Appr.oval Date