HomeMy WebLinkAboutApplicationGurfield County
BUITDING PEF!\iî IT
AFPI.jCATONùmmun ity Devel opment Depart ment
1 OB Bth Sreet, S.lite 401
Genwood $rings, @81601
(s7o)s+5-8212 î'lAR 0 I 20ll
www.qarfield-county.com
ü!l DemolitionH Ocmmercial/Multi-Family
E Manufadured Home (Sngle or Multi-Level)
lji.i FÞroofB Fbddential (S, DuplexorTownhome)
t
Fhone: (9?o \ 7l I - 2316Property Oruner:
MailingAddress:
EinailAddress:
7
Ocntrador:Phone: ú7o , î?l '/06ê
MailingAddress:
BnailAddress:
1o î/r/
t t
Ardrited Phone: I )
Mailing Address:
EinailAddress:
Ehgineer:K., I ll l¿mm ¿2ç Fhone: û^it t î71-/04ê
MailingAddress:
Einail Address:
o li ît Po"lht l^/l f,,
Manufadured Home ln$aller:Phone: ( )
MailingAddress:
Einail Address:
Describe Work:
Jcb Address:7 C...ßl 2 ,
Assessor's Farcel Number:
$b
x ?^6v-^ o23
LI,1 I
þ&q,fuøt
Lot
.4
Eock _
Oruner'sValuation of worf.ßN 21¡r" ã Roperty Sze (Q. Ft. or Aøes):
Q. R. of Brilding:lL?o Fleight 2f t-# of Floors: I
Öassof Work:!$Ne*L'$JAlteration Li{lRoo¡t¡on LIil FÞoair-)ü3J Move/Felocation
Caraç Li¡JRttacfred ,L,Ð(Detacl'red
FRCI,EçT DEIìAI 1,S æNT NUED
Septic o\\fis munity
Eedric Other llou
Driveway Fermit:Exempt turmit #:
NOÏCE
Authority. This aPPl ication for a EÐilding Èrmit mud be dgned by the Oruner of the property'described above,
hority, signed byor an authorized agent. lf t he dgnature below is not that of the Oivner, a separate letter of aut
the Oruner, mud be provided with thisþplication.
Leqal Access. A fuilding Fermit cannot be issed without proof of legal and adequate accessto the property for
purposes of inspedions by the fuilding Divisjon.
Other Fermits. Multiple separáe permits may be required: (1) Sate Eedrical Èrmit, (2) Òunty OWTSÈrmit,
1S¡ "*tfr"r permit required for use on the property identified above, e.g. Sate or County Highway/ Fbad Access
or a Sate Wa$ewater Dsdrarge Èrmit.
Void permit. ABllilding furmit beæmesnull and void if theworkauthorized isnot commenced within 180 days
of the date of isilance and if work is suspended or abandoned for a period of 180 days after commencement.
I hereby certify thá I have read this Application and that the information contained above istrue and
underSand that the Building Dvison accept s t he Appl i cat i on, al ong wit h t he pl ans and specf i cat ions
corred. I
and other
data s¡bmitted by me or on my behalf (submittals), based upon my certification asto accurary. Assuming
completeness of the slbmittals and approval of thisApplication, a Blilding Èrmit will be iss]ed granting
permisdon to me, as Oruner, to conúrud the úrudure(s) and facilities detailed on the submittals reviewed by
in" auitOing Division. ln consderation of the issuance of the fuilding furmit, I agree that I and my açntswill
complywitñ provisionsof any federal, Sate or local larru regulating thework and the Garfield Ocunty Blilding
Ccde,-OWtsregulationsand applicable land use regulations(Oounty Ègulation(s)). I acknowledgethat the
fuilding Þrmit may be srspended or revoked, upon notice from the Ocunty, if the location, conSrudion or use
of the $rudure(s) and facility(ies), described above, are not in compliance with ùunty Fbgulation(s) or any
other applicable laru.
I hereby grant permisslon to the fuilding Dvision to enter the property, described above, to insped the work. I
furtheiacknowledgethat the isflance of the tuilding turmit does not prevent the Rrilding Official from: (1)
requiring the corredion of errors in the slbmittals, if any, discovered after is$ance; or (2) dopping
condrudion or use of the úrudure(s) or facility(ies) if sJcl"ì is in violation of County Ègulation(s) or any other
applicable law. Èview of thisApplication, induding ilbmittalq and inçedionsof the work by the tuilding
Dvison do not congitute an acceptance of reçonsjbility or liability by the Oounty of errors, omisdons or
disoepanoes. AstheOruner,lacknowledçthatreçonsbilityforcompliancewithfederal,Sateandlocalla¡vs
and Ocunty Fbgulations red wìth me and my authorized açnts, induding without limitation my archited
neer and/ or builder
I hereby acknowledç that I have read and underSan d the Notice and Grtification above, as well as, have
provided the required information which iscorred and acctlrateto the bed of my knowledç.
CÅuuA"s (3- r- 2e/2
Ðoperty Oiv nt and Sgn Date
E Ropanel-!!lNatural@sType of Heat
OFFIOALUSON¡LY
$ecial Conditions:
Misc Fees:Manu home Fee:r\rA,Fermit. Fee:
¿.d nsAdiu$ed Valuation
zh>. z4O
Han Check Fee:
2¿13 .t o
OWTSNo
[.r i Ê.
BPNo: l
'faAE q(ot2ffiffl'.",Due:Total kes:
145 íf
Zoniño:a'TßL'Ocn$ Type:
ÃYFå:,Stbacks:
2 I çrïv lf) c,n
-Àb.2al
Date
BUITDING / HANNING DIVISON
,l ù Z+ûLr of
Gaqfieltl
Buildins^l Zonins Plan Review Checklist
Permit Number:bc\t - ol-/7-4t"1¿
Brrilding Plannine/ Zoning
/
^t 'l
L >* UÍ7^Engineered Foundation
Driveway Permit
Soils Report
D./L svrlneHeight
---4rrning sign-off
^/,4
Rorad tmpact Fees
--Zoradel
ro posr aphy 40%
tJ,rl"
ñ
Property Line Setbacks
30 ft. Stream Setbacks
l,( tl, Ftood ptain
Planning lssues
Subdivision Plat
(/,4
'-/ surveyed site Plan
/,/,1 .septic Permit and Setbacks
Topography 30%
Attach Residential Plan Review List
ision Plat Notes
Fire partment Review
ion Determination/ Fees
R Line Plans/ Stamps/ Sticker
ch Conditions
,l.l .
General Comments:
to Sign Application 168o "*f
/g
70, z4o
le No
Letter - Manu. Homes
and/or plans for compliance, the application may be placed on hold until the required information is
provided. Work may not proceed without the issuance of a permit.
The Building Division will collect a Plan Review fee at time of application submittal. The permit fee, as
well as any Road lmpact fees will be collected when the permit is issued.
The permit application must be signed by the owner or by person having written authority from the owner
to act as their representative.
Building cannot be occupied until a Certificate of Occupancy (CO) is issued. Using the building without a
CO will be considered an illegal occupancy and may be grounds for vacating the premises. (Final/CO
inspection requirements will be attached to your approved field set of plans.)
I hereby acknowledge I have read, understand and will abide by the requirements of this
checklist.
i^+2 (:
Property Print and Sign Date
e