HomeMy WebLinkAboutApplication.pdfREC4 Garfield County OCT 3 0 lal*nmunity Development Department GARFIELD COUNTY 108 8th Street, Suite 401 )MMUNITY DEVELOPMflf,nwood Springs, CO 81601 (970) 945-8212 www.garfield-county.com
TYPE OF CONSTRUCTION r 0 CO;~lIne~iaI7Multi-Family o Manufactured Home (SF or Duplex) I 0 Residential (SF, Dupl~Townhome) INVOLVED PART'-'.IE""S'---__ _ l)! Demolition 10 Reroof Property
Owner: ))a f.e ·Fu han k. Phone: ( 170 ) 9'(,3-4500 Mailing Address: ( b 7& elf! 100 I CtJ.r-boPlcla'/p ) Co ,/?l'b'2.3 -' Contractor: ~e ~OJ:.EIC CoIX)! 7AJC. Phone:( 9.-1? ) 99'P"'?o>3
Mailing Add:S: 0/9 ;t1,o65 ihu,t Ut1R60,u !;'!1t{~ Co .. ? /6;;) ~ r Architect: ________________ Phone: ( ______ _ Mailing Address: ________ ~ ______________ _ Engineer: ________________
Phone: ( __ , _____ _ Mailing Address: -====:-___________________ Manufactured Home Installer: __________ Phone: ( ______ _ Mailing Address: ________________________ _ PROJECT NAME AND
LOCATION Describe Work: &m~-;;-e>( is -!;/1Q $ fruclu;-e. tV/fer/it \,J (D r: 1(;,7(;' C ~ /00. 0 /5 Il1dude.s Job Address: (6 7 {7 C/:! /tJC) tlell f Af 2..---Assessor's Parcel Number:
03«13 3(,3 COOI~Ub. ________ Lot __ Block __ I Owner's Valuation of Work: $ _______ Property Size (Sq.Ft or Acres): ____ _ Sq.Ft of Building: _______ Height: =-__ -:;:::::;;:;:=_ # of
Floors:, ____ _ Class of wory 0 New 0 Alteration I 0 Addition I 0 Repair 0 Move/Relocation Garage: /' 0 Attached 1 + -O-D-~~~ched i I Septic: /0 I~~S I Type of He~ L Natural Gas t Drivewa~it:
I 0 Exempt L _._ o Community I 0 Propane .L r 0 Eie~tric I 0 Other ,. 0 Permit #: ______ _ I
[ NOTICE --~~~= Authority. This application for a Building Permit must be signed by the Owner of the property, described above, or an authorized agent. If 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
1505 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. I Void Permit. A Building
Permit becomes null and void if the work authorized is not commenced within 180 days of the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
r CERTIFICATION r I hereby certify that I have ;ead this AP~lication and that the information contained above is t~~ 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 I 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. In 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, 1505 I regulations and applicable land use regulations (County Regulation(s)). I acknowledge that the Bui lding
Permit I may be suspended or revoked, upon notice from the County, if the location, construction or use of the structure(s) and fa cility(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 I further acknowledge
thatlhe issuance of the Bui lding Permit does not prevent the Building Official from: (1) I requiring the correction of errors in the submittals, if any, discovered atter 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 I 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 under nd the Notice and Certification above as well as r ect and accurate to the best of my
knowledge. 10//7 /}71 OFFICIAL USE ONLY Special Conditions: Adjusted Valuation: Plan Check Fee: Permit Fee: Manu home Fee: Mise Fees: --t1)(),S . -~ Total Fees: Fees Paid: Balance Due:
BP No: ISOS No: ~&5'-~. -tiYnO-j04D Setbacks: OCC Group: Const Type: Zoning: I \ /\ Y .,--J, \ ~JA /i? /O'~-2DB BUILDING /PLANNING DIVISION " ,Tt--., '~ApproV'1 ~ Date '~6,:>~'~~?-