HomeMy WebLinkAboutApplicationGurfreld Caunty
Community Development Department
--.108 8th Street, Suite 401
RËCEIVéiPn*ood springs, co 81601
,¡ri i û';i;)i (9701945-8212llri' ot t'iÁri"*.garfield-countv.com
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BUILDING PERMIT
APPLICATION
DemolitionCom mercial/M u lti-Family
Manufactured Home (Single or Multi-Level)
t ReroofResidential (SF, Duplex or Townhome)
Accessorv Dwellins Unit (ADU) - MAXIMUM SIZE OF 1,000 SQUARE FEET
Property Owner:
Mailing Address:
Email Address:
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Phone:Architect:
Mailing Address:
Email Address:
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Phone: (Engineer:
Mailing Address:
Email Address:
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Manufactured Home lnstaller:
Sub.
Property Size (Sq. Ft. or Acres):
# of Floors:_
Owner's Valuation of Work: S
Sq. Ft. of Building:
Assessor's Parcel Number:
Job Address:
Mailing Address:
Email Address:
Describe work: 1"o. olL
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I lnooitionClass of Work:New Remodel/Alteration
Garage Attached Detached
n¡tySeptic:cwrs
Electric OtherType of Heat:Natural Gas Propane
Dr¡veway Permit #:
Authoritv. ThisapplicationforaBuildingPermitmustbesignedbytheOwneroftheproperty,describedabove,
oranauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedby
the Owner, must be provided with this Application.
Lesal 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. 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 cert¡fy that I have read this Application and that the information contained above is true and correct. I
understand thatthe Building Division acceptsthe Application, alongwith 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 constructthe 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) orany
other applicable law.
I hereby grant permisslon 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
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 neer and/ or builderr,
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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Property Owner Print and Sign Date
Special Conditions:
Permit Fee:{ loô .¡o
Manu. Home Fee:
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Misc. Fees:t,t/¡Adjusted Valuation:Plan Check Fee:
Balance Due+ú BP No:
eoof -tu53 OWTS No:
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Total Fees:
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Fees Paid:
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Const. Type:
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Zoning:
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Setbacks:fOCC Group:
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BUILDlNG / PTANNING DIVISION
DateSigned
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