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. MÆ(IMUM SIZE OFUn¡t FEET
Email Address:
Phone:Property Owner:
rA.?q'l-¿ COak- Ti'ltli,\\¡rr r I e9p.,LMailing Address:
Remodel/AlterationNewClass of Work:
Garage:
Mailing Address:
Email Address:
Contractor:Mcrr rô\ f),,Phone: tQlo I &lLl-? 5 51
Mailing Address:3Lq .1hov vTìrln ( brarrl ,ÕYl co so3
Email Address:ÉN rrno{ ø Ìnnn . C
Arch¡tect!
Engineer:Phone:
Email Address:
Manufactured Home lnstaller:
-
ñ>hone:
Describe Work:
Job Address:
Assessol's Parcel Number:ô6 I-¿MZ \l LA
Sub. !ot'-- Elock
owne/svaluation of Work, S l1,, Ll4Q Property Size (Sq. Ft. or Acres)
Sq. Ft. of Building: Height:I of tloors:_.--
Mailinß Address:
Mailing Address:
Email Address:
I
'
Attached Detached
Sepüc:OWTS Community
Type of Heat:Natural Gas Propane Electric Other
Authority. 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 authority, signed by
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 propefi for
purposes of inspections by the Building Division.
Other Perm¡ts. Multiple separate perm¡ts may be required: (L) 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.
Permit #:
l-lExempt
Driveway
Pe¡mltl
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 Bu¡lding 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, OWIS regulations and applicable land use regulations {County Regulation{s}). I acknowledge thãt 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 gu¡lding Permit does not prevent the Building Official from: (1)
requiring the correction of errors in the submittals, if an;', discovered after issuance; or (2) stopping
construction or use of the structure(s) or faciliiy{ìes} il'';irch i: in vìolation of County Regulation(s) or any other
applicable law. Review of this Application, irrclucin¡: :::::i.¡::.rìrì.,ìi, and inspeclions of the work by the Buìlding
Division do not constitute an acceptance of re:l¡ri;i,rì:ì r'', .' i¡' i;ltitility by the County of errors, omissions or
discrepancies. As the Owner, I acknowledge tl¡i:l ' ¡,i:ilit.v i'or compliance with federal, state and local laws
,., r,,i:¡ ìl-c. rncluding without limitation my architectI and County Regulations
I designe_r,_enalegl 11d1
rest with me and mV ãrillìi:'. i. ;'
or builder
I hereby acknowledge that I have read and u¡Tder:itâÌìiJ the nlslice and Certification above, as well as, have
provided the required information which is correct and acctl¡ate to the best of my knowledge.
ovCoS rt
Property Owner Print and Sign Dâte
U
OFFICIAI USE ONLY
Special Conditions:
Permit fee Manu. Home Fee:Misc. Fees:Adjusted Valuation:Plan Check Fee
Balance Due:BP No:OWTS No:Total Fees:Fees Paid:
Zoning:OCC Group:Const. TyperSetbacks:
EUrtDlNG / PLANNTNG DTVISION :
Signed Approval Date