HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
'108 8th Street, Suite 401
.ri. jr i j i G]en,lvgod Springs, CO 81601
,r, ii: ,,, (970) g4'_92t2
www.gaifield-cou ntv.com
i, l, ".,: .',',:iol
BUILDING PERMIT
APPLICATION
TYPE OF CONSTRUCTION
E Commercial/Multi-Family tr Demolition
tr Manufactured Home or Tiny Home (Single or Multi-Level)
tr Residential (SF, Duplex or Townhome)tr Reroof
tr Accessorv Dwelling Unit (ADU) - MAXIMUM SIZE OF 1,200 SQUARE FEET
INVOLVED PARTIES
97-?
Phone: tTaKl _sl7a1
Email Address:
Property Owner:
Mailing Address:
Phone:+s a
(,
t?
-LZContractor:
Mailing Address:
Email Address:
Phone:(Architect:
Mailing Address
Email Address:
Phone:7
L
Engineer
Mailing Address
Email Address
Phone:Manufactured/ Tiny Home lnstaller:
Mailing Address
Email Address:
PROJECT DETAITS
Describe Work:
Height:
r
Owner's Valuation of Work:s
5q. Ft. of Building
Assessor's Parcel Number:
Sub.
Property Size (Sq. Ft. or Acres):
# of Floo
Job Address:
I /3 etoct
E Addition E Repair tr Move/RelocationClass of Work:E New E Remodel/Alteration
E DetachedE AttachedGarage:
PROJECT DETAILS CONTINUED
E Community
E Electric
Authoritv. ThisapplicationforaBuildingPermitmustbesignedbrTtheOwneroftheproperty,describedabove,
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.
VoidPermit. ABuildingPermitbecomesnullandvoidiftheworkauthorizcdisnotcommcncedwithinlsOdays
of the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
CERTIFICATION
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
provided the required info on which is correct and accurate to the best of my knowledge
3- 17 - zaLs-
Owner Date
Type of Heat:
Septi€:E] OWTS
E Propane E other
Driveway
Permit:
E Exempt E Permit #:
NOTICE
lherebycertifythatlhavereadthisApplicationandthattheinformationcontainedaboveistrueandcorrect. lunderstand
thst the Building Division accepts the Application, along witlr tlre plaus arrd specifications arrd otlrer data subnritted by rrre 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 ofthe structure(s) and facility(ics), dcscribcd abovc, arc 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
dLKiluwreuBc Lildr Lilc rssudnce or rne Duilarng rerrnrl ooes noI prevenl Ine builotnS uTltctat Trom: l-ri requtnng Ine correclton
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
bytheCountyof errors,omissions,ordiscrepancies. AstheOwner, lacknowledgethatresponsibilityforcompliancewith
federal, state, and local laws and County Regulations rest with me and my authorized agents, including without limitation my
neer an or builderarchitect des
OFFICIAL USE ONtY !
Special Conditions:
Adjusted Valuation:4 2*:, -,/ UL/\
Plan Check Fee4.o^4 la-l
-1 l\+^ \
tr"'l"l'fT'l<
el-tl o t-
Manu homefee:* -Misc Fees:
t1''1":' cqf-Ils. |J t
Fees Paid: .llaA lr,l
a(?1+'. r-r Balance Due:
- -.t . L(-t-{ql-'tr
BP No:aT ArrllKl(n.1l|-tl
OWTS No
Setbacks:OCC Group: .-h-(Const Type: TB '7*U
- -. nta3 .Lt'4JBUTLDTNG / PLANNTNG DTVTSTON :
Date5ignedproval