HomeMy WebLinkAboutApplicationGarfield County
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Dwelli Unit (ADU)- MAXIMUM SIZE OF 1,200 SQUARE FEET
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Describe Work:
Job Address:
Assessor's Parcel Number:
Sub.//A rct /l/4 etock f'/A
Owner's Valuation of Work: S
4 (Sq. Ft. or Acres)
# of FloorsSq. Ft. of Building:
Class of Work:
Height:
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BUILDING PERMIT
APPLICATION
WPE OF CONSTRUCTIONxCom mercial/M ulti-Fa mily Demolition
Manufactured Home or Tiny Home (Sing le or Multi-Level)
Residential (SF,Duplex or Townhome)Reroof
INVOTVED PARTIES
U.J
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Phone: €7a I 7/f9-'nZ
Email Address:
Property Owner:
Mailing Address:
Phone: t?71
,€ '/r"r fir' i .4*-lurc' Phone: t?7, I
Email Address:
3q - /6A1F
./--/Phone:1a- 1 357-V67<.-,l,l,b.de
Engineer:
Mailing Address:
Contractor:
Mailing Address:
Email Address:
Mailing Address:
Email Address:
Architect:
Phone:(Manufactured Home Installer:
Mailing Address
Email Address:
PROJECT DETAITS I t
t'- .
;
Garage:Attached
od ation
Detached
77/8*':
s€ptlc:tD(CWTS Communlty
Type of Heat:I Gas Propane Electric Other
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 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.
Permit #:Driveway
Authoritv. This application for
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 detail'ed on the submittals reviewed by the Building Division. ln
consideration of the issuance of the Building Permit, I agree that I ind my bgents witt tompfu with' provisions of any
federal, state or local law regulating the,work and the Garfield County Building Code, OWTS r,egulations and
apRlicable land use regulations (County Reguldtion(s)). All County develipment requiring p permit, except for
residential uses are subject to Article 7 of the Land Use and Developmeht 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
structuie(s) and facility(iqs), described above, are not in compliance with County Regulatibn(p) 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 Buildjng Official from: (1) requiring
the correction of errors in the submittals, if any, discoveied after issuance; or (2) stoppihg 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 discrepaqcies. As the Owner, I
acknowledge that responsibility for compliance with federal, State and locil laws and County Regulations rest with
me and my authorized agents, including without limitation my architect designer, engineer and/ or builder.
he ce that have this icati on nd Itherebyrtifyread inedconta na correct.dtr.ueApplrmationnfoaboves
u derstandn ththat Bue ild Division the thwith nsla andingacceptsApplication,dan dataotheralongpspecifications
I hereby acknowledge that I have read and understand the Notlce and Certlflcatlon above, as well as, have
provided the required information which is correct and to the best of my knowledge.
s/a/aq
oat{ I ,Property Owner Print and Sign
'Qut*f-<*aSnaeiel l'nnr{iflnnc.
Adjusted Valuation:18,67L.ns Plan Check Fee:Ssn- gq Permit Fee:Bt4t,l15
'fuanri'. Homb Feei Misc. Fees:[t5z3.c<
T{QL,'q Fees Pald:
b-14,+<)
Balance Due:7tg.'-{H BP No:
Rt fn OWTS No:
Setbacks:occ GrounT -=Const. Type:\6 '7+:i-
BUILDING / PLANNING DIVISION :3-21-4
Approval Date
