HomeMy WebLinkAboutApplicationGarfield Coun'ly
O>mmunity Development Department
108 eth areet, SJite 401
Glenwood ~rings, CD81601
(970) 945-8212
www .aarfield-county.com
T't'FEOF CDl\ISTRJCTI~
O Cbmmerdal / M ulti-Fanil y
.0 -Manufactured 1-bme (S:orDuplex)
Jir Fesidential (S:, Duplex, or Townhome)
'
I D Demolition
I Y FEroof
\
A-operty ONner: -.i.....11...1..:..;....x..::......J:.---::'.~..M:lr.~=-==---r"rr""
M ailing Address: _...:...;::;...._~~-.;ii......:.=.;....:;.;:;;....;::.:..::..1.~:.....&.-u...::::......:.........L..;:;~-....-...;....;;o~:t==-=.:..:
Cbntractor: ________________ Alone: (._ _ __, ______
1
Mailing Address: ________________________ _
Architect: ________________ Alone: <~-~> _____ _
Mailing Address: ________________________ _
Engineer: ________________ Alone: '--~·------
Mailing Address: ________________________ _
Manufadured Home Installer: __________ Alone:(......._ _ _, ______ _
MailingAddress: ________________________ _
Oassof Work: 0 New 0 Alteration O hldition O R:lpair D Move/R:llocalion
Garage: 0 Attached
~tic: D I~
Type of Heat : Natural <?as D A-opane D 8ectric D Other
Driveway Permit: O Exempt
NOTICE
Authority. Thisappllcation for a &Jilding Permit must be signed by the 0.Vner of the property, described above, or
an authorized agent. If the signature below is not that of the 0.Vner, a separate letter of authority, signed by the
0.Vner, must be provided with thisApplication.
legal Am:!ffi Aa.Jilding Permit cannot be issued without proof of legal and adequate access to the property for
purposes of Inspections by the &Jilding Ovision.
Other Permits. Multiple separate permits may be required: (1) Sate Bectrical Permit, (2) Cbunty IIDSPermit, (3)
another permit required for use on the property identified above, e.g. Sate or Cbunty Highway/ R:>acl Aa:essor a
Sate Wastewater Os:tiarge Permit.
Vold Permit. A &Jilding Permit beoomes null and void if the work authorized is not commenced within 180 days of
the date of iSS1.Jance and if work is suspended or abandoned for a period of 180 days after commencement.
CB'mRCATION
I hereby certify that I have read thlsApplication and that the information contained above is true and oorrect. I
understand that the &Jilding Clvision 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 aca.Jracy. Ass..lming
completeness of the submittalsand approval ofthisApplication, a &Jilding Permit will be issued granting
permission to me, as O.Vner, to canst ruct the structure( s) and fad lit ies detailed on the submittals reviewed by the
B..Jilding Ovision. In cxmsideration of the ISS1.Jance of the &Jilding 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 Cbunty SJilding Cbde, ISJS
regulations and applicable land use regulations(Cbunty Fegulatlon(s)). I acknowledge that the SJilding Permit
may be suspended or revoked, upon notice from the Cbunty, If the location, construction or use of the structure(s)
and facility(ies), described above, are not in compliance with Cbunty Fegulation(s) or any other applicable law.
I hereby grant permission to the SJilding Dvision to enter the property, described above, to inspect the work. I
further acknowledge that the iSS1.Jance of the SJilding Permit does not prevent the SJilding Official from: (1)
requiring the oorrection of errors in the submittals, if any, dis:overed after issuance; or (2) stopping construction
or use of the structure(s) or facility(ies) if such Is In violation of Cbunty Fegulatlon(s) or any other applicable law.
R:Mew of this Application, induding s.ibmittals, and inspections of the work by the SJilding Clvision do not
constitute an acceptance of responsibility or liability by the Cbunty of errors, omissions or discrepancies. As the
0.Vner, I acknowledge that responsibility for complianre with federal, state and local laws and Cbunty Fegulations
I rest with me and my authorized agents, induding without limitation my architect designer, engineer and/ or
builder.
I hereby acknowledge that I have read and understand the Notire and certification above as well as
have provided the required information which is correct and acx:urate to the best of my knowledge.
&>.~ /[,l-"f -I L{
A"operty Orvn 1 ~-Date
OfflCALUSEONLY
~al Cbnditions:
Adjusted Valuation : ACll Oleck Fee:
p
Permit Fee: 7> ~
MC11u home Fee:
BalanmDJe:
~ co
OCX::G-oup:
BUILDING/ R.ANNINGDIVISON: ~A [1~
Sgied Approval
+\:ud Q . t,S: /9
\J \-sd ~ICJO. ~
Misc Fees:
ft