HomeMy WebLinkAboutApplicationGarfield County
BUILDING PERMIT
APPLICATION
R$'{;ffi mun Development Department
jr ri.r ll r- iilgp 8th Street, Suite 401'I'r"'etijii*oodSprings,co81601
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TYPE OF CONSTRUCTION
Y Commercial/M ulti-Family Demolition
Manufactured Home or Tiny Home (Single or Multi-Level)
Residential (SF, Duplex or Townhome)Reroof
Accessorv Dwelling Unit (ADU) - MAXIMUM SIZE OF 1,200 SQUARE FEET
INVOTVED PARTIES
Property Owner:
Mailing Address:
o 4 Phone: (Fo I 727 il7 o €
I
Email Address
Contractor:Phone: (_)
Mailing Address:
Email Address:
Architect:Phone:
Mailing Address:
Email Address:
Engineer Phone: (_)
Mailing Address:
Email Address
Manufactured Home lnstaller:Phone: ( )
Mailing Address:
Email Address:
PROJECT DETAITS
Describe Work:Ca^.La
Job Address:wo , ./l
Assessor's Parcel Number:
Sub.Lot Block
Owner's Valuation of Work (Property Size (Sq. Ft. or Acres):'loo sQ il
Sq. Ft. of Building:t-Lft)Height:il' r I f of Floors:_
Class of Work:New Remodel/Alteration Addition
Garage Attached Detached
PROJECT DETAILS CONTINUED
lherebycertifythatlhavereadthisApplicationandthattheinformationcontainedaboveistrueandcorrect. I
understand that the Building Division accepts the Application, along with the plans and specifications and other data
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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
conside!'ation of the issuance of the BLrilcling Per'mit, ! agree that I and my agents will eomphT 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 Development 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
structure(s) and facility(ies), described above, are not in compliance with County Regulation(s) or any other
applicable law.
lherebygrantpermissiontotheBuildingDivisiontoentertheproperty,describedabove,toinspectthework. I
further acknowledge that the issuance of the Building Permit does not prevent the Building Official 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 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 discrcpancies. 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 designer, engineer and/ ot builder.
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
provided the required information which is correct and accurate to the best of my knowledge.
T-, L Vl)6_ vl- %ontl
Property Owner Print and n Date
Septic:f,WTS
Type of Heat:Natural Gas Electric
Community
OtherPropane
Driveway
Permit:
pt
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.
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.
VoidPermit. ABuildingPermitbecomesnull andvoidiftheworkauthorizedisnoLcomntetrcedwithirtl80days
of the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
Permit #:
CERTIFICATION
NOTICE
OFFICIAT USE ONIY \
Special Conditions:
Adjusted Valuationa7@-66 Plan Check Fee:qq,.e
1
Permit Fee:t5>.25 Manu, Home Feel Misc. Fees:
Total Fees
-
t- /\^L>L.l6,to
Fees Paid:Aatt\'\"1 ,vl Balance Due
rF- aFr> t.L>
BP No:.t5-l--7 F nA tA.wy b,-YF,'ftJr
OWTS No:
Setbacks:Const. Type:,o"rT,^lOCC Group:
BUILDING / PTANNING DIVISION
Signed Ap Date
6 -(1 -Z+