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Home My WebLink AboutApplicationGurfield County ent BUILDING PERMIT APPLICATION WPE OF CONSTRUCTION E Commercial/Multi-Family El Demolition E Manufactured Home (Single or Multi-Level) I Residential (SF, Duplex or Townhome)Reroof ¡NVOIVED PARTIES Property Owner: Mailing Address: Email Address: l("^ l;, L.arsrn Phone 6)1ù (if-llöt 3Zt Oa alau ln,,Ju ò gl tú¡ Kun 4Y( {-n I @ ltt " ( itv,'¡r 81 eo, PROJECT DETAILS {\Vt^*( krl," L*,Describe Work: Job Address:t Assessor's Parcel Number: @@ 6ôl 5ub.Lot Block Owne/s Valuation of Work: a.d Size (Sq. Ft. or Acres): I * O6 \ hc,'et r"l?D I 3ô"1 W3( 4H I Co"o{'rJ,b,',tn c-G l,^c'l Mailing "o Bøt= E ç" Ç [e^*.'ÅSF-rrr'^<ì, CO Elool'Address: ìl'cor" \ òEmail Address: Contractor: Architect: Phone: Mailing Address: Email Address: ¡{" I O¡ t J êL t (à Phone:1.lo t \( 'l't8 - L?61Engineer: Mailing Address: Email Address: Mailing Address: Phone Email Address Manufactured Home lnstallen I t'lew llAlteration ll ndd¡tion þn"R"it Move/RelocationClass of Work: fttt..nuo ! oetachedGarage: Sq. Ft. of Building:3óc>ø SÇ'- tu.) Height: Property * or loors: I Ll) R^ *e tv*,^Å , E(ommunitYSeptic: !(rtectric Otherl_lNatural Gas ! Propane >< Type of Heat: Driveway Permit: I PROJECT DETAILS CONTINUED OWÏS Exempt Permit #: NOT¡CE Authoritv. This application for a Building Permit must be signed by the Owner of the property, described above, oran authorized agent. lf the signature below is notthatof the Owner, a separate letterof authority, signed by 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 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. CERTIFICATION I hereby certify that I have read this Application and that the information contained above is true and correct. 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 Owner, to construct the structure(s) and facilities detailed on the submittals reviewed by the Building Division. ln consideration of the issuanceof the Building Permit, lagreethat land myagentswill 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)). 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 d r, engineer a or builder I hereby acknowledge that I have read a understand the Notice and Certification above, as well as, have provided ired information which correct and accurate to the best of my knowledge /ø t/r r/2"> / g Owner Print and l"n 7 t OFFICIAT USE ONIY Special Conditions: Permit Fee:q b4?j,Manu home Fee:Misc Fees:Adiusted Valuation+'w,0Ø.Ø Plan Check Fee:+4tø.41 Balance Due:Qto&te ffiú'^úb OWTS No: I--nw-Tota Qlt I F'ees: 067.t4 Hll'l,t,t ConstType: IRC Zoning:(zSetbacks: FIR=2ö,9=to oCC Group: IRO BUITDING / PLANNING DIVISION Siqned Approval zlølzorc DateI tg )14 | ê¿;;*;¡re;;;ç) BuítdÍns^l Z¡oning Plan Revi ew Checklist Perrnit umber:çLKE- A2-16 -Þt02 l-Atfun Fttvvøà¿l Buil ns Planninc/ Toning Surveyed Site Plan SePtic Permit and Setbacks Grade/Topography 30% '/- Attach ResidentíalPIan Review List "/ subdivísion Plat Notes '/ Engineered Foundation '/ Driveway Permit 19¡ N/e / Attach conditions '/ Application Signed '/ Plan Reviewer to Sign Application Parcel/schedule No. I.w / Grade/Iopography40% General Comments: I'y N/a N/A Property Line Setbacks 30 ft. Stream Setbacks Flood Plain Building Height Zoning Sign-Off Road lmpact Fees Fire Department ReYíew Planning lssues '/ Valuation Determinatíon/ Fees '/ subdivisíon Plat Red Line Plans/ Stamps/ Sticker N.Soils Report 40# Snowload Letter - Manu. Homes ualw(w o(tl,tork= 9nØ- (aç qubùvùil¿B) R0^à lnpact F,.e- - N/4 (r, ,w LwbtøH¿ tr)