HomeMy WebLinkAboutApplicationI
Cgmmunity Development Department
108 8th Street, Suite 401
iiliii . ,Glqlgtood Springs, cO 81501' '(970) e4s-8212
www. gaifiel dcountyco.govffi
Garfield County
WPE OF CONSTRUCTION
DemolitionCom mercial/M ulti-Fami
Manufactured Home or Home le or Multi-Level)
ReroofResidentialF, DU lex or Townhome)
Accesso Dwell Unit - MAXIMUM SIZE OF SQUARE FEET
BUILDING PERMIT
APPLICATION
O l
INVOTVED PARTIES
Property Owner:
Mailing Address:
Sr^^ t S\a^rrra Phone: t47e I el "efr26
tE4 Bl,tc l.feoo*. a ( Co *tr,o(
Email Address:9cz.n , ,Ap $locaeg @ a5ftrn 9no wmq(99lc" corryr
contractor: D- U- N ea!-'^ (L"r Co',g{. (;.Phone E S -?Stl
Mailing Address ir o 1 q{A S*" CL$S Co P to,o I
Email Address:se.Lro*. € crl,t t"rt.v ,'^Cs nn
Architect:t, {4 Phoner ( )
Mailing Address
Email Address:
Engineer:Nrr€ To e(Es Phone: f 7zo f Q96 ' 8.l E"l
Mailing Address
Email Address:
*/n
rr(s Let .b;
Manufactured Home lnstaller:Phon e:(
Mailing Address
Email Address:
PROJECT DETAITS
Describe Work:
a'a-Ae
AAI dh rtt/css J l.a^ &wf)s loL 6^
"^4 4r
Job Address:l9{rl ts l.r \\,pro,.
Assessor's Parcel Number:
Sub \Pss Ba IPCE Lot Block
Owner's Valuation of Work: S 000 .-Property Size (Sq. Ft. or Acres):
Sq. Ft. of Building:# of Floors
\l"r br'to ur rt
Class of Work:New Remodel/Alteration f Addition
Garage:Attached Detached
PROJECT DETAITS CONTINUED
I
Septic:]WTS
Type of Heatr Natural Gas Propane Electric
Community
Other
Permit #:
NOTICE
Driveway Exempt
Permit:
i ,.{*,*
t .,t,
Authoritv. Tlri.sapplicatiorrfnraBrrilc.lirrgPernrif rlusthesigrrer,l lryfheOwnernftheproperty,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.
tegal Acceii,. A Building Permit cannot be issued without proof of legal and adequate access to the property for
pui"poses'of inspections by the Building Division.
Oth6r 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 andvoidiftheworkauthorizedisnotcommencedwithinl80days
of the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
CERTIFICATION
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 othcr 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
uwner, [u Lunsr.ruL[ (ne sUuul,urets, anu taciltues uetaileu on tne SuolliltrdtS revreweu oy ure DuilullrH, urvrsroil. ilr
consideration of the issuance of the Building Permit, lagreethat land myagentswill complywith 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 my authorized 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
required i is correct and accurate to the best of my knowledge.
b'",7 ,,
Owner Print and Sign Date
OFFICIAT USE ONLY
speciat conditions: 5 6€ 4{/tt.iD tTttrl1.t-I,€aT?58--
fdjusted Valuation:1 rs .3co-e>
Plan Check Fee:
t-72.4\
Dormi+ Eoo.zc$_5 Manu. Home Fee:Micr Eaoc.
Total Fees:
457 e Fees Paid:
l7z-11
Balance Due:Zc;-5 BP No:ffip43rt OWTS No:
Setbacks:OCC Grouo:'5F*Const. Type:'Wb
e-za-zsBUILDING / PLANNING DIVISION
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