HomeMy WebLinkAboutApplicationGørfield County
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Community Development Department
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Commercia ulti-Fam molition
Manufactured Home e or Multi-
Residential , DLI or Townh Reroof
Accessory Dwelling Unit - MAXTMUM SIZE OF 1,000 SQUARE FEET
INVOLVED PARTIES
Property o*n.r.(¡ÉPt¡l5 lrc.¿yt,lv.c. t^LC.phone: tl1o tz}s- zblÁ
Mailing Address:l't 3 b=.t*o^tu , rl e PAør*,.-r. Cù StUSf
Email Address:
Contractor:SÂut¿ .Âs ¡{çal¿Phone
Mailing Address:
Email Address:
BUILDING PERMIT
APPLICATION
Architect:Phone: I )
Mailing Address:
Email Address:
Engineer:G¿*xst¿ P E¿r PSc-A-rrôÁ.f Phone: tþ] I 1-12 "727{
t^)Z6olMailing Address:
Email Address:
Manufactured Home lnstaller:Phone:t)
Mailing Address:
Email Address:
PROJECT DETAII.S
Describe Work:4 rs-
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Job Address:S \^)z S P.\^J ¿3.{lb
Assessor's parcet Number: lqt I -?:11- DÒ' Dl Z
Sub.lot Block
Owne/sVafuatignofWgrk: S <D, OtÐ. OO Propertylize (Sq. Ft.orAg¡es):3 1zz qcr¿s
sq. Ft. of Building: (2G SU . €'ìr-lo'f of Floors: tHeight:
Class of Work:Addition
(
Garage:
ew Remodel/Alteration
Detached
Septic: N /A Communlty
Type of Heat:Gas Propane Electric Other
Driveway
Permit:tr Permit #:
AuthoriW. This application for a Building 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 authorit¡ signed by
the Owner, must be provided with this Application.
Lesal Access. A Building Permit cannot be issued without proof of legal and adequate âccess 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.
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 (21stopping
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, a¡d inspections sf the work by the Building
Division do not constltute 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 lim¡tat¡on my architect
e neer an or builder.
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
provided the required information which is correct and accurate to the best of my knowledge.
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Owner Print and Sign Date
see /pru>/n¿//sSpecial Conditions:
onoo'i'iyil""Plan Check Fee:
?tr?, t5 Misc.lüsz .,
'*Aî+"'Fees Paid:* zq.tl BP NO:
Buco -?51?
'"uü:vs EV
a
OWTS No:
¡tle.
Setbacks occ@oue:
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colglf¡¡pe:-
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Zoning:
R. u.
BUttDTNG / PTANNtNG DtVtStON :
Signed Approval
@z
Date
t
NOTE: lf any required information is missing, delays in issuing the permit are to be expected. lf
determined by the Building Official that additional information is necessary to review the application
and/or plans for compliance, the application may be placed on hold untilthe required information is
provided. Work may not proceed without the issuance of a permit.
The Building Division will collect a Plan Review fee at time of application submittal. The Permit Fee, as
well as any Road lmpact fees will be collected when the permit is issued.
The permit application must be signed by the owner or by a person having written authority from the
owner to act as their representative.
I hereby acknowledge I have read, understand, and will abide with the requirements of this
checklist.
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rty Owner Print and Sign Date