HomeMy WebLinkAboutApplicationGaY��zar co u n�
108 8'4 Street, Suite 401, Glenwood Springs, CO 81601 I , lvpr�
Ph:970-945-8112 Fx:970-384-3440 Inspection Line:888-868-5306
Www, ear field-countv.com
BUILDING PERMIT APPLICATION
G,11171=ICI 1 : (;( ;, IiVl Y
I
Parcel No, (this information is available at the assessors aice 970.945-9134) Lot No: Block No: Subd,i Exemption ? i P N N iVG
1 '-77 11 359 NIA
2
lob Address: (ifan address has not been assigned, please provide CR, HWY or Street Name & Cit}>) or and legal description
ban Check Fee:
28730 Highway 6 & 24 Rifle, CO 81650 Section: 11 Township., 6 Ran e: 93 A TR IN THE SENE SEC 11
3
Owner: (property anmer)
Mailing Address: Ph:
Alt Ph:
Misc Fees: Avwmye
Bayou Well Services LLC
same as above 970-625-0552
4
Contractor:
Mailing Address: Ph:
Alt Ph:
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PNCI Construction
553 25 112 Road, Grand Junction C0970-242-3548
5
Manufactured home installer:
Mailing Address: Ph:
Lic #:
6
Architect.,
Mailing Address: Ph:
Alt Ph:
Johnson Carter Architects PC
136 E 3rd. St. Rifle CO 81650 970-625-0580 _
7
E lacer:
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Mailing Address: Ph.
AGOD Z4--7(6 — 2�
Alt Ph:
BL . DEP
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Sq. Ft. of Building:
Sq. Ft. or Acres of Lot. i. T Height:
No. of Floors:
13.26 Acres �
one
9
Use of Building:
Class of Work:
❑Residential ®Commercial IIOther
❑New ftcration []Addition ❑R air ❑Demo ❑Move
l0
.Describe Work'O
I 1
Garage:
Septic: NIA
Type of Heat:
[]Attached []Detached
❑ISDS ❑Community
❑Nat. Gas []Propane ❑Electric ❑Other
12
Driveway Permit:
Owners valuation of Work:
$15000
NIA
NOTICE
Authority This application for a Building Permit must be signed by the Owner of the propeny, described above, or an authorized agent. If 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 access to the property for purposes of inspections by the Building Department
Other Permits. Multiple separate permits may be requited: (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.
_Vold 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 1 have read this Application and that the information contained above is true and correct. 1 understand that the Building Department 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 structures) and facilities detailed on
the submittals reviewed by the Building Department
In consideration of the issuance of the Building Permit, l 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 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,
eonstruttian m use of the stnrcturr(s) and facility(ics), described above, are not in compliance with County Regulation(s) or any other applicable law.
I hereby grant permission to the Building Department 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; (l) requiring the correction of errors in the submittals, if any, discovered after issuance, or (2) stopping construction or use of the structurc(s) or facility(ics) 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 Department do not constitute an acceptance of responsibility or liability by the County of errors, omissions
or discrepancies. As the Owner, I ackn wledge 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, engin: ' ilder.
1 HE E THAT p D UNDERSTAND THE NOTICE & CERTIFICATION ABOVE
OWNERS N DATE
W �, 3j vj i cc— q,?o1, � STAFF USE ONLY
Special Conditions:
Adjusted Valuation:
ban Check Fee:
Permit Fee:
Manu home Fee:
Misc Fees: Avwmye
23,
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Total Fees:
Lfa_6, t
Fees Paid:
Balance Due:
2q2. 8D
RP No & Issue bate:
-�
ISDS No & Issued Date:
_ t
l b3.51
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Setbacks:
FtS6 �g zv S) O'
OCC Group:
Const Type:
arg
Zoning:
BL . DEP
7 /%Z
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APP VAL
DATE
APPROVAL
DAT