HomeMy WebLinkAboutApplicationGarfield County
BUILDING PERMIT
APPLICATIONCommunity Development Department
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INVOLVED PARTIES
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Demolitionfl Commercial/Multi-Family
n Manufactured Home (Single or Multi-Level)
¡Reroofffi Residential (SF, Duplex orTown home)
Property Owner:
Mailing Address:
Email Address:
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s"lP Phone: f19-7 2Oa *toEq
Contractor:
Mailing Address:
Email Address:
Architect:
Email Address:
Phone: (
Mailing Address
Engineer: Phone: (-)-
Mailing Address
Email Address:
Email Address:
-
Phone: (_)
Height:Sq. Ft. of Building:
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Lot
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Owner's Valuation of Work: 5 ffi)5a0
Block _
Manufactured Home lnstaller
Property Size (Sq. Ft. or Acres):
# of Floors:_
Describe Work:
Mailing Address
PROJECT DETAILS
Job Address i srD
Assessor's Parcel Number:
Sub.
tlR¿uit¡on ! Repair ll Move/RelocationNewl_lAlterationClass of Work:
! oetached!RttactreoGarage
understand that the Bu ilding Division accepts the Application, along with the plans and specificati
PROJECT DETAITS CONTINUED
Septic:OWTS Community
Electric
Driveway Permit Permit #
NOTICE
Authoritv. This application for a Building Permit m ust 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 authority, signed by
the Owner, must be provided with this Application.
LegalAccess. A Building permit cannot be issued without proof of legal and adequate access to the property for
purposes ot inspecttons by the Bulldlng Dlvisiorr.
Other permits. Multiple separate permits may be required: (1) State Electrical Permit, (2) County OWTS Permit,
(g) ,*ti'"l. permit required for use on the property identified above, e.g. State or County Highway/ Road Access
or a State Wastewater Discharge Permit'
Voidpermit. ABuildingpermitbecomesnull andvoidiftheworkauthorizedisnotcommencedwithinL80days
of the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
CERTIF¡CATION
I hereby certifY that I h ave read this Application and that the information contained above is true and correct. I
ons 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 Permitwill 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 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, 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 plication, including submittals, and inspections of the work by the Building
Division do not constitute ance of responsibility or liability by the County of errors, omissions or
discrepancies. As the edge that responsibility for compliance wlth federal, state and local laws
and County Regulati nd my authorized agents, including without limitation my architect
engineer
read and understand the Notice and Certification above, as well as, have
provided the n which is correct knowledge.
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Property Owner Sign Date
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and accyrate to the best of mY
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Other! eroprne
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Type of Heat:
Exempt
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Special Conditions:
Misc Fees:Manu home Fee:¡tPlan Check FeeAdjusted Valuation
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BP No'¿aBalTó0tN,
ZoningConstOCC Group:Setbacks:
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BUILDING / PLANNING DIVISION :
Signed Approval Date