HomeMy WebLinkAboutApplicationGarftcld County
BUILDING PERMIT
APPLICATIONCommunlty Dcvelopment Department
REGEIVED tog Bü Street, Sulte ¡Ol
sEP I 4 zota
u'""*ËloìTl!:;'r:181501
GARFtELDcour.¡rW
COMMUNITY
Demolition
Manufactured Home (Single or Multi'Level)"[!]
Ceroo¡I Residentiat (!F, Duplqx orTowrþ1n_e)
i Property Phone:
MalllngAddress;
Emall Address:
Contrãctûr:
Malllng Address:
Email Address:
Archltect:Phone:
Maillng
Email Address:
Engineer:Phone :T
c
Malllng Address:
-
' Emall Address:
Manufactured Home lnstaller:Phone:
Malllng Address:
Emall Addres¡:
Work:
Job Address:
Assessor's Parcel Number:
5ub.[ot- Block
Owne/s Valuatlon
Sq. Ft. of Bullding:
of Work:Property Slze (5q. Ft. or Acresl:
Helght:lû of Floors:-
Class of Work:Repair
Garage:
New lEan.'ttion 1
Detached
Move/Relocation
Sepüc:lov,fß I Gommunity
flotherl_lrtearic
l-lPermltf:
i irl rr ¡,¡
Type of Hcrt:Natural Gas Propane
Ddveway Pernlt:Exempt
Authorlty. This application for a Buildlng Permit must be signed by the Owner of the property, described above,
or an authorized agent. lf the signature below is not that of the Owner, a separate letter of authoriÇ, signed by
the Owner, must be provided with this Application.
leral Access. A Buílding Permit cannot be issued without proof of legal and adequate access to the property for
purposes of inspections by the Building Division.
Othe¡ Permits. Multiple sepârete permits may be required: (1) State Electrical Permit, (2) County OWTS Permit,
(3) another permit required for use on the property identified above, e.B. State or County Highway/ Road Access
or a State Wastewater Discharge Permit.
Vold Permlt. A Building Permit becomes null and void if the work authorized is not commenced within 180 days
of the date of lssuance and lf work is suspended or abandoned for a period of 180 days after commencement.
I hereby certiry thet I have read this Applicatíon and that the information contained above is true and correct. I
understand thet 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 eccurecÏ. 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 deta¡led on the submittals rev¡ewed by
the Eullding Dlvislon. ln consideration of the íssuance of the Building Permit, I agrec that I and my agents will
comply with prov¡sions of any federal, state or local law regulating the work and the Garfield County Building
Code, OWTS regulations and applicable land use regulations (CounÇ Regulation(s)). I acknowledge that the
Building Perm¡t mey 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 perm¡ss¡on to the Building Division to enter the property, described above, to ¡nspect the work. I ,
further acknowledge that the íssuance of the Building Permit does not prevent the Building Officlal from: (1)
requiring the correction of errors in the submittals, if any, discovered after issuance; or (21 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 acceptence of responsibility or liabilíty by the County of errors, omissions or
discrepancies. As the Owner, I acknowledge that responsibility for compliance with federal, state ãnd local laws i
and my authorized agents, including without limitation my architect
I hereby acknowledge that I have read and understand the Not¡ce and €ertlflcatlon above, ¿s well es, have
provlded the requlred informatlon whlch ¡s Gorrêct and accurate to the best of my lnowhdge.
n
Property Owner hlnt and Slgn
I l.g
Dete
r.i .j :lr,r l.l (':'^'r I [,;ì,'
Speclal Condhlons:
-'"ñT1Yd'*'"'Plan Fee:M¡nuoo Kl"a
åi'ffi.oo CN o&
'"'KT'lß OCC 6rouo::r90 '"rytn,
8Ulr"D|NG I Pt ANt{lNG D|VIS|ON :
Slgned Approval