HomeMy WebLinkAboutApplicationGurfield County
BUILDING PERMIT
APPLICATIONREC EIVEIDmmunity Development Department
108 8th Street, Suite 401
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INVOTVED PARTIES
Property Owner:
Mailing Address:
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Phone:4"lo ?{r- ?32e
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Email Address:
PROJECf DETAIIS
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Job Addressl
Assessor's Parcel Number:
Sub,
Owner's Valuation of Work: S
Lot Block _
Property Size (Sq.
# of Flo
t
Demolition
WPE OF CONSTRUCTION
n Comme Iti-Fam
Reroofor Townhome)
or Multi-Level! Manufactured Home
Residential (SF, Du
Phone: &?0 )b/t.bbç+Dr";,u¿.qJ Kr"Contractor:
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Mailing Address:
Email Address:
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Email Address:
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Mailing Add
Architect
Phone: (_)
Email
Mailing Address
Engineer:
PhoneManufactured Home lnstaller:
Mailing Address:
EmailAdd
! R¿d¡tion ffi Repair Move/Relocationll AlterationClass of Work:p trtew
flDetached!RttachedGarage:
Sq. Ft. of Building:
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Height:
Ft. or Acres)
PROJECT DETAITS CONTINUED
Septic:OWTS Community
Driveway Permit:Exempt Permit #:
NOTICE
Authoritv. This application for a Building Permit must be signed by the Owner of the property, described above,
oranauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedby
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 Division.
Other Permits. Multi ple 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.
VoidPermit. ABuildingPermitbecomesnull andvoidiftheworkauthorizedisnotcommencedwithinlS0days
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 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 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
er e an or builder
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
provided information which is correct and accurate to the best of my knowledge.
Property Owner Print and Sign Date
ll Propane l_l Electric
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OtherType of Heat:Natural Gas
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IOFFICIAT USE ONtY ôo
Special Conditions:
Fees:lnMisc
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Adjusted Valuation
ñ\ lA Plan Check Fee:Nln Permit Fee:
$1oô.P
Manu home Fee:
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Fees Paid:S76¡ oo
Balance Due:
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BP No:
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Signed Approval
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Date
BUILDING /