HomeMy WebLinkAboutApplicationt.-- ..-'- . .'-
\
{inr$etd C*w$y
Com nrunity Eevelopmelrl Dcpadmemt
1S8 8th stre€t, Suite 4S1
€lenwood Springr, t0 81601
{9?S} 945-8?1a
ny$|f; nilrsld " c gllslg:igln
TNVOLVEO PA{fl8$
o,F 1,200 sQ{rARf Fftt
ilion
pr€pertv o1rrfl€r;
Ma,ilring Address:
Email Address:
{-V f.\\,r ,/*fi\rhone {11}d-1\tl
Contracior:
Ma;iling Add.ress:
€Fhoae;i)\
I r1 LiLr fl, , ^,^tr.: ll r.\i\,, ^[ h,r.n: {.- ,r *ii:1\
: lflail
Ar,chit€ct:
Engine er
;Ema,il
,',"r11.\ .ts{* - \,t rf ,c.l { la;il tlah,-o,, { t; n
Fhone:
.Ma{iing l\ddress:
' {l'n.ail Ad.dress:
*ron e : $fslr \*5a3] f,-:c
tr,{aii.ing Addres5;a Qo.
cr,4-1 l'--\if .7\;' 6)lr,-,Itcr, \ . Ct.t,\
f)
..-.. _.--_ Ph.s.ne; {
JVlaj{ing Add,r€ss. -.,,.,_-__._
€,r'nai1 /lddr.ers:
FROJgCT $T''AIL5
Ma{luf.acture d llotne futstaile,r;
0escriba Wollt:
]i t*b l)C\ ( c'l Lt
J.Db.Add.r{]is:115' i /1, rt,',, 1 '- ,-!,.:,l\ (r,
Assesgo,r''s Fareel Nut;:ber:
Sub.Lot 8{ork
Ovsne r's V:luatjon o.f \,4l,o.rk: 5 . rProJ:erty 5i:e {Sq, F{. sd AcrlsJ: i i.'
-il of floors:5q. Ft. 0f 3ui{dir.tg:
Cl:s; r:f Vrrork:
Garcgc:
ll'.le iglrt;-t I i
lrl L;; cit cd
iirlLlil. isn
Dc l,,rrhr:ri
BUILDING PERMIT
APPLICATION
illl R errr ocirt;'al t1 r!, r I r L1n
II
PROJ ECr OrtArrS coilniluio
Sepfir:Comrnu.niity
Type o$ +{*at;Gas Fropane rEic.ctrlic ,Otlrer
Orfu'cuay
flerEnit
,lkrrr,nit iU:
NOTICE
,Autllorlfv. Thts applicatiore for a Euilldi,ng F,ennrrt mrlst be signe,U Uy Itr,e Owncr oi tn,e ;pr,ope.ry., 'd,cscr,ibed a'bove,
or an authoni.?'ed .agent. il{ th,e signature below ,is no't ,*i.at of th,e Own€r, .a sep.a'cat€ l.etier of authority, signe.d by
tihe Orrn.er, must. b€ pr'ovidod with t;his Apsli'c,atiofl.
g.€FatA.{e56. ASuildingP,ernr'ittannotbeiser.{€'dwitftoutipr,oo{'old.egal and,adequ,ate,at'cesstothepr.opertytor
pr.rrp.oses of insipectior's hy ttle I.lildring Division.
Othen Fer*arits- ;L4'sl;tipl,e separat€ penrnits rnay be r.equ,ired: {!l S{,ate [:lect'rical Perlnrit, {2i'Couq"rty OWTS Permit, ,
{3} .another pe'rrnit r'equined for use on dir'e pr,ope.rty ,identifi,erii a'bov,e, e.g- Stat€ ,.o,r County tiighway/ *oad Access
' 'or.a State Was{€water Dilrrharge P€,iff+it.
' Void FerrEait- A Bui]ding lPe'rrnii b'ec'on'res nvll and void ,if ;the wqrk .*urhori:,e*il is ,n'ort ,cornrnenc.ed w,ithin XEO days
I o{ the ,rjate ,of iss.u.a,nce and if wor* ris suspended ,or abandoned for.a ;peried ,of lSO days af:t,er,commen'cement.
ctRnRcATtont
rt'terei:vc,ertirythatit"uereaJtW.nfiprti.rtirnan,ottatiired;@;;;ii;;;,c'ontjinecl ibov.elstrucardrorr ert. il
: understand thar the Eu ilding Divi5isn .acc€pts tl*'e /6plication, atong witrh the plans ar,rd sperif ications and other .daia
, subrn;tted hy me or,on irny'behal;i i(subnnittalsfi :b.a.'e'dl !.poo flry 'certi{i'cafi'GTr a5 to ad,curacy. Assurning,oontpleite,ness
: o{ the subrnitta'ls and app,r,oval o{ this psplicat+oa" a Euri:lding lPernrit will be is-.rued ,gcantin8 per'mis:,ion to mf , as
Owner, rto cons$uct the slrlrcture(sf a'rld facilities detailed €n th€ sut'miltals aeviewed,by tihe Euilding Eivislon. iln
considerati.on o{ the issuar,rce of (he Suildiog tPeffr.r{'{, { .agr€s ihat !I ao'd rny ag€nts will cor,npiy wi{ih prcvisions of any
{edera1. stat,e or {G{ail law rcg,ul.atirng the work and tth'e 6arr{ield Coun{y lBuilding,Code" OWfs regr:.1ations and
I .a:pp{icabl'e la'nd use r,egu,lations {County :R€€ulatisn,{sN}. Ai{ Coumty deve*opnrnent requil-rirrg a perm'it, ex@pt Sor
r reslderitiall uses" ar€ s,ub$ect to Artide 7 of ithe {-andrUse aod Oevetloprrie'r0t trrod€- t ack*owledge that ihe Euildir;g
I Ferrnii rr,ray be snrspended ,or revoked, 'up,on 4"@ti{e f{,ori, .{he Oounity, ,if the location, ,cons{ructrion ,Gr use of the
, st,ructur,e{sl and f.ac{lify,{iesl, 'descriitlrcd aibove, are nc{ ifi csmplfutrc€ with,County tReglrlati'on{s:}or any otir€r
r applicable law.
t hereby gr,ant penrnissiofl rto the Builc{irrg Division to eni€r th€ r}r€periy, d€scrihed above, do inrsp€ct th,€ work. il
: f,urther a,cknowiedge t'h.at tlh,e 'issuance,of the Er,rilding F.ermait does *ot prevenrt tihe Euilding gfficial fr'om: {!.} reqr,riring
, the col.ecti.ol:t ,of enrors 'in the subrniittals, l{ ,any, di:covered after .issuance; .rr {2i stcpping constructijon cr use ,of the
struqt,udq(si €r f,aciljty,(ie s) if sr.rch iis in v,iolatio* o{ {oxiaty fiegr.rlation(si or ,any,other appli'cabie tlaw. R€vieu'/ of th js
I Applicar-i.on, inrl.udlrilg s,ubrnittals, and riels;peclions of tfie ra,ork by the 8.uildi'ng Division do nat ccnstitirt€ an
. acceptanc'e of responsibility or ,liiabil;ty hy tihe ,Coun{y of ernors" ,ormissionl or dircrrepanrcies. As the Ewnei, I
ack,nowledg€ tih.at r€sponribiliti/ for cornptiance rrjth fed€r'al, sta{€ ar+d local {arvs a:nd {'ouc{y fiegulaticns rett B..ith
me and rny auth'orized agerlis, includir€ wit0ns,L{t.lifilitatt'€.n nny archit'ect desi6iner, erig;noer and/ 'or builder.
I here&y acknorriedge that I haue read and snderitand the 0lotice and Certiificatiom ahove, as well as, have
provided th€ r€quir€d idforrnatbn ryhich is correct and accu.-Fte to ltle best of rny *aowledge.
Properry owner Print and Sigm Date
OFfifi,ATI.JSS OflTY
Special
To N{r- C.n-rfic--c<retLConditions:
Flan Chpc* Fec:
I Lts- lf P€trnit feel'2?r,25 illilansr. *lorrae f,"ee:tulisc" feer:Adiusted Valuatisn:
l?-,606
Salaoce Oue:227.6 8P ftllo:
fr-mzg.- hTotal F€es:
369.39 i.rig ll 0WTS i{o:
)
OC{ Group:Consl- iype:zonant2Setbacks:
<:) 47 22
L> -LU?L-)8Lt{LOdf{G / f'l..Strfd8il{6 DrrV{S|Otr :
Date