HomeMy WebLinkAboutApplicationGarfield County
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BUILDING PERMIT
APPLICATION
DemolitionCommerciaUM ulti-Family
Manufactured Home {Single or Multi-Level}
ReroofResidential {5F, Duplex or Townhome}
Accessorv Ðwellins Unit {ADU} - MAXIMUM 5lZË OF r,200 SQUARË FËEÏ
Property Owner:
Mailing Address:
Email Address:
Fhone: tî"f"Q I 57î,atsd
-Jñjlcaø-ì" Ltleørlls
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(J'll-^h^.lz \,À ll,.p C*'J*
gb 3-?"q¡Sþ ¿h,âr\Sf, *ô¡? 7 e{íà
Emall Address;
Pct l?*"" 9l( /n-k^nj^l
Phone: ( qTa I ?liz-SqlL-
Malllng Address:
Contractor:
îm Rl h2<
Archltec* Phone:
Mailing Address;
tmallAddress:
I
Engineer:Phone: { )
Mailing Addres¡:
Email Address:
EmailAddressi
Owne/s Valuation of Work: S-
Describe Work:
y'op
Phone¡I
Block
Property Sire (Sq. Ft. or Acres)r
fl of Floors:-
Manufactured Home lnstaller:
Mailing Address
Job Address:
Assessor's
Sub. Lot
Sq, Ft. of Building: Heighh
i RemodefÅlteratien i *UAitioni'Cls¡¡ Ef lÂfork;
DetachedGarage:Attached
owTs CommunitySeptlc:
Natural Gas Propane Electric OtherType of Heat:
Drþew¡y Exempt Permit S:
Authoritv. This application for a Building Permit must be signed by the Owner of the property, described above,
or ãn authorized agent. lf the s¡gnature below is not thãt of the Owner, a separate letter of authority, signed by
the Owner, must be provided with this Application.
[e#al Access. A Euilding Permit cannot be issued without proof of legal and adequate åccess to the property for
purposes of inspections by the Building Division.
Othgf Perm¡ts. 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. Slate or CÐunty Highway/ Road Access
or a Stãtê Wastewater Discharge Permil.
Vqid..fl,ernlit. 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 suspe nded or abandoned for a period of 180 days after commence ment.
I hereby certify that I have read this Application and that the information contained above is true and correct. I
understand that the Building Ðivision accepts the Application, along with the plans and specifications and other data
submitted by me or on my behalf (submittals), based upon my certification a5 to accuracy. Assuming compleìeness
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)). All County development requiring a permit, except for
residential uses, are subject to Article 7 of the Land Use and 0evelopment Code. I acknowledge that the Building
Permit may be suspended or revoked, upon notice from the County, if the location, construction or use of the
rtructure{s) and facility{ies), described above, are not in compliance vrith County Regulation(s) or any other
applicable law.
I hereby grant permission to the Building Þivision to enter the properly, desffibed äbove, to inspect the work. t
further acknowledge that the issuance of the Bu¡lding Permit does not prevênt the Building tfficial from: {1} requiring
the 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 submittäls, and inspectians of the work by the Suilding Þivision dü not constitute an
äcceptâncê of responsibility or liabiliiy by the Çounty of errors, omissions, or discrepancies. As thê 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 årchitect designer, engineer and/ or builder.
t:?
I hereby arknowledge that I have read and understand the Not¡ce and Certification above, as well as, have
provided the required information which is correct änd accurate to the best of my knowledge.
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Owner Print and Sign Dätê
(t-t-23
Special Conditions:
Permit Fee:j?^r.4 Manu. Home Fee:Misc. Fees:
NwWuat¡ûn:
Plan Check Fee:
zô8.9\
BP No¡
ËKD -g&g OWTS Nor'iö8'.o.,Balance Due:
45g.oG
'pi*iDSetbacks:
Total Fees:
5ãı.o6
OCC Group:Const. Type:
BUTTDTNG / PT.ANNTNG DlVrSrON:
Approval Date