HomeMy WebLinkAboutApplicationCommunity Development Department
108 8th Street, Suite 401
(e7ol94s-82L2
www.Fa rfi eld-cou ntv.com
Garfuld County
BUILDING PERMIT
APPLICATION
Accessorv Dwellins Unit (ADU) - MAXIMUM SIZE OF 1,200 SQUARE FEET
ReroofIResidential (SF, Duplex or Townhome)
Commercial/Multi-Family Demolition
Manufactured Home or Home or Multi-Level
ryPE OF CONSTRUCTION
Garage:DetachedyAttached
KClass of Workl Remodel/Alteratio.nNew Addition
iteight:
Describe Work
Lot
I
P +
Owner's.Valuation of Work Property Size (5q. Ft. or Acres):
# of Floors
Job Address:
Block
Sq. Ft. of Building:
Assessor's Parcel Number:
Sub.
PROJECT DETAIIS
)(Phone:Manufactured Home lnstaller:
Mailing Address:
Email Address:
)Phonel (Engineer:
Mailing Address:
Email Address:
Architect: Phone: (_)_
Mailing Address:
Email Address:
/ra A
Phone:t 17a \ 7e/ -1284Contractor:
Mailing Address:
Email Address:
phone:tfZA) jY-9 2737
06Email Address:
Property Owner:
Mailing Address:
INVOLVED PARTIES
l'(P'n-
CERTIFICATION
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
^l i^^-^^!:^.^^ L.- !L^ n..:ll:.^- h:..:-:^.-[iurPU5c5 ur il r>pcLLruil5 uy Lr re Duiluil rE, utvt5tun.
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 'vvasiewaipr ltischarge Permii.
VoidPermit. ABuildingPermitbecomesnull andvoidiftheworkauthorizedisnotcommencedwithinl80days
of the date of issuance and if work is suspended or abandoned for a period of L80 days after commencement.
NOTICE
ExemptDriveway
Permit:
Other
Permit #:
ElectricPropaneNatural GasType of Heat:
Community3WTSSeptic:
PROJECT DETAII-S CONTINUED
I hereby certify that I have read this Application and that the information contained above is true and correct. I
understand that the Building Division accepts the Application, along with 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.
lherebygrantpermissiontotheBuildingDivisiontoentertheproperty,describedabove,toinspectthework. I
further acknowledge that the issuance of the Building Permit does not prevent the Building Officialfrom: (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
acceptanceof responsibilityorliabilitybytheCountyof errors,omissions,ordiscrepancies. AstheOwner, I
acknowledge that responsibility for compliance with federal, state and local laws and County Regulations rest with
me and my authorized agents, includirrg without linritatiorr rrry arclritect desigrier, engineer and/ or builder.
I hereby acknourledge 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.
/Prop"rry Owner Print and Sign Date
Zonine:q&f,).Const. Type:OCC GroupSetbacks
OWTS No:
ffie-gqrro
Balance Due:ooFees Paid:
lrYl.
Total Fees:trn .oo
Misc. Fees:Manu. Home FeePermit Fee:\cn,ooPlan Check Fee:Adjusted Valuation:
Special Conditions:
. (f , \cl -\R',a4OFFICIAT USE ONtY
BUTLDTNG / PLANNTNG DTVTSTON
Signed Approval Date