HomeMy WebLinkAboutApplicationrfield Cow nty
, ¿lopment Department
rreet, Suite 401
^.. iprings, CO 81601
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field-countv.com
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Demolitionulti-Fa
C Home (Single or Multi-Level)
5F, Duplex or Townhome)Reroof
uelling Unit (ADU) - MAXIMUM SIZE OF 1,000 SQUARE FEET
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Madactured Home lnstaller:
Maillg Address
Enral Address:
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Height:
allAssessor,s parcel Nurnb er: ,2 3 ç5ô it c)0
Lot _ Block
Job Address:
Sub.
Property Size (Sq. Ft. or Acres):
#of
Owner,s Valuation of Work: S
sq. Fr. of Building:
Class of Work:
Remode l/Alteration Addition
Garage Attached Detached
PROJECT DETAILS CONTINUED
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
provided the required on which is correct and accurate to the best of knowledge.
Property Owner Print and Sign
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Comm'unitySeptic:WTS
Electric OtherType of Heat:
XNaturalGas
Propane
Permit #:Driveway
Perm¡t:iX'u'n'
NOTICE
Authoritv. ThisapplicationforaBuildingPermitmustbesignedbytheOwneroftheproperty,describedabove,
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.
iple 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.
Other Permits. Mult
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 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)). lacknowledgethatthe
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)
requiringthe 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
des êf,neer and/ or builder
CERTIFICATION
OFFICIAL USE ONtY
Special Conditions:\)
Misc. Fees:4ÒCo.öoPermit Fee: - -2112,1>
Manu. Home FeeAdjusted Valuation: I Plarf Check-Fee;7(3,61L
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!6&.10
Balance Due:
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BP No:Efn4V;5 OWTS No:ffiS\orTotal Fees
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Fees Paid:
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OCCGroup: 5_(
Const. Typei....^
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Setbacks:
þ-5t -?-3BUILDING / PLANNIN6 DIVISION :
DateSigned Approval