HomeMy WebLinkAboutApplicationGarfield County
RE GılVñDr¡ty Development Department
108 8th Street, Suite 401
.JUt i * ,lëlËn*ood springs, co 81501
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BUILDING PERMIT
APPLICATION
TYPE OF CONSTRUCTION
Commercial/M ulti-Family Demolition
Manufactured Home (Single or Multi-Level)
Residential (SF, Duplex or Townhome)I Reroof
Accessory Dwelling Unit (ADU) - MAXIMUM SIZE OF 1,000 SQUARE FEET
INVOTVED PARTIES
Property Owner:
Mailing Address:
Phone:I
Email Address:
Contractor:Phone, Ê7o wq- ?qql
Mailing Address:
Email Address:
Architect:Phone: ( )
Mailing Address:
Email Address:
Engineer:Phone:
Mailing Address:
Email Address¡
Manufactured Home lnstaller:Phone: (_)
Mailing Address:
Email Address:
PROJECT DETAITS
Describe Work:
Job Address:
Assessor's Parcel Number:
I
Sub.Lot Block
Owner's Valuation of Work: $Property Size (Sq. Ft. or Acres): \ C\. OCI
Sq. Ft. of Building:rmq Height:fof
/
Class of Work:New Remodel/Alteration Addition
Garage:Attached Detached
PROJECT ÐETAIIS CONTINUED
Community
Exempt
NOTICE
Authoritv. This application for a Building Permit must be signed by the Owner of the property
or an authorized agent. lf the signature below is not that of the Owner, a separate letter of au
, described above,
thority, signed by
the Owner, must be provided with this Application.
Legal Access. A Building Permit cannot be issued without proof of legql 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.
Voidpermit. ABuildingPermitbecomesnull andvoidiftheworkauthorizedisnotcommencedwithinlS0days
of the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
CERTIFICATION
Il
Septic:
OtherPropaneE lectricNatural GasType of Heat:
Permit #:Driveway
Permit:
I hereby certify that I have read this Application and that the information conta ined 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 grant¡ng
permission to me, as Owner, to construct the structure(s) and facilities detailed on the submittals reviewed by
the Bu¡lding 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 Perm¡t does not prevent the Building Official from: (1)
requiring the correction of errors in the submittals, if any, discovered after issuance; or (2) stopping
construct¡on 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
desi er neer and/ or builder
I hereby acknowledge that I have read and understand the Notice an d Certification above, as well as, have
provided the req information which is correct and accurate to the best of my knowledge'
Property Owner Print and Sign Date
60'tOFFICIAL USE
Special Conditions
Manu. Home Fee:
L\/r+Plan Check Fee:
ï.) lA Permit Fee:slry). ooAdjusted Valuation
BP l'{o:
QrvrP- s/¿f o
owfs tr¡o:[TlH'l^ff,w'Fees Paid:
$ren.@
Total Ëees:
$tØ,oo
Const. TvDe:Ì?ii ftnins:
Setbacks:f\llA OCC Grouo:E2p
f
ß Lnt,-' +/nfnBUITDING / PLANNING DIVISION :
Signed Approval Date