HomeMy WebLinkAboutApplication.pdf-C Garfreld County Community Development Department RE CEIVEl\ 108 8th Street, Suite 401 . :J U lenwood Springs, CO 81601 (970) 945-8212 SEP 0 3 1013 www.garfield-countv.com GARFIEL
DCOUNTY IMMUNITY DfV~IDI!JIEGONSTRUCTION 0 Manufactured Home (SF or Duplex) o Commercial/Multi-Family ~ Demolition INVOLVED PARTIES Property Owner: Wrs '" tt.-M} M 4--~r--e L 10 10 Mailing
Address: 3,,1 rI /tP7 fooo .'e..v 4) Contractor: "'?-e..-{ F Mailing Address: Architect: Mailing Address: Engineer: Mailing Address: Manufactured Home Installer: Mailing Address: PROJECT
NAME AND LOCATION Describe Work: (/c.-"C w-~I $I-f-e.-f) 7 Job Address: c)7 f/e-iZ-I , 7 t-(~ Assessor's Parcel Number: !t.3q~~O\lHO-o~~ub. Owner's Valuation of Work: $ Residential (SF,
Duplex, or Townhome) Reroof Phone: ( ., 7cJ ) '-77-7/cJ]_ c....w~ c.., 'i'( 'v( Phone: ( ) Phone: ( ) Phone: ( ) Phone: ( ) ~~ $~ Go Lot Block --Property Size (Sq.Ft or Acres): ~ , .
. . Sq.Ft of Building: Height: tJ. t Mt 1<' '1 " of Floors: Class of Work: o New I 0 Alteration I 0 Addition o Repair I 0 Move/Relocation Garage: o Attached o Detached Septic: o ISDS
o Community Type of Heat: o Natural Gas I 0 Propane I 0 Electric I 0 Other Driveway Permit: o Exempt o Permit":
-----------------~---------------------------~-~ ,t. This application for a Building Permit must be signed by the Owner of the property, described above, or J(horized agent. If the signatu
re 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 access to the property for I purposes of inspections by the Bui lding Division. Other Permits. Multiple separate permits may be required : (1) State Electrical
Permit, (2) County ISDS 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. I hereby certify that I have read this Application and that the information contained above is true and correct . I understand that the Building Divis
ion accepts the Application, along with the plans and specifications and other data submitted by me or on my behalf (submittals), based upon my certifica tion as to accu racy. Assuming
completeness of the submittals and approval of this Application, a Building Permit will be issued granting I permission to me, as Owner, to construct the structure(s) and facilities
detailed on the submittals reviewed by the Building Division. In 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, ISDS I 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 structu re(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 compl iance with federal, state and local laws and County Regu lations 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. ~ Property Owner Print and Sign Date ~fFI~IAL USE ONJ. Vi , --Special Conditions: Adjusted Valuation: Plan Check Fee: Permit
Fee: Manu home Fee: Mise Fees: $~' ---Total Fees: Fees Paid: Balance Due: BPNo: ISDS No: ~~. -$9$,-~S5.-tfyV'O ~ ~q1-~ Setbacks: OCC Group: Canst Type: Zoning: \\/\ R~ BUILDING I PLANNING
DIVISION : ~ \ , J-{ ,M 3 2lJ3 \~ Siiked !\Jproval Date