HomeMy WebLinkAboutApplicationi
*Community Development DepartmentKeCE,V6f.Brh Street, Suite 401
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Gurfield County
BUILDING PERMIT
APPLICATION
,l'
TYPE OF CONSTRUCTION
DemolitionCom mercial/Multi-FamilY
ReroofResidentialDuor Townhome
Accessory Dwell Unit
or Multi-LevelManufactured Home or TinY Home
- MAXTMUM SIZE OF 1,200 SqUARE FEET
INVOLVED PARTIES
Manufactured Home lnstaller: Phone:
Mailing Address:
EmailAddress:
PROJECT DETAILS
Describe Work:
Job Address:Ll. Pa.e^zl',,\= - f^D. 8Ib3S
\4o \\ie Atk''". Phone: $ 7 ot 116 ^ 7l7c)
3
Email Address:
Property Owner:
Mailing Address:
eoll'rc r
3
Phone:t1lO l6\$-7f Ul
Mailing Address:
Email Address:
Contractor:.iL Eor^
EmailAddress: , .
Phone: (-_)Architect:
Mailing Address
Engineer: Phone:
Mailing Address:
EmailAddress:
I
RemodeUAlterationNewClass of Work:
Assessor's Parcel Numb"r, )\ O 7 t ( QOICttl,? -
Sub.1\orr,^*.,.nV (t tV lot K Btotk 1
owner's valuation of Work: S [-/ 50O -'
sq. Ft. or Buirding: J)1 ^l Sf*?"'t Property Slze (Sq. Ft. or Acres):
Garage:Attached
ight:
-
# of
Detached
DETAITS CONTINUED
Propane
Community
Electric Other
Permit #;
-
Driveway
Permit:[-lExempt
NOTICE
Authoritv. This application for a Building Permit m ust 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'
Lesal 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 owrs 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 L80 days
of the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement'
CERTIFICATION
l
Natural GasType of Heat:
I hereby certify that
understand that the
I have read this Application and that the information
Building Division accepts the Application, along with
contained above is true and correct. I
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 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 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.
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) 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 discrepancies' As the Owner, I
acknowledge that responsibility for compliance with federal, state and local laws and County Regulations rest with
me and myauthorized agents, including without limitation my architect designer, engineer and/ or 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.
A.l ?a- q-a4
Property Owner Print and Sign Date
OFFICIAL USE ONIY
Special Conditions:
Misc. Fees:Manu. Home Fee:Fee:n
BP No;OWTS No:Balance Due:(.olFees Paid:\a
valuation:@
bConst. Type:OCC Grpup:Setbacks;
7^bzJ
BUTLDTNG / PLANNlNG dtVtStOtU
DateSigned