HomeMy WebLinkAboutApplication·---------TYPE OF CONSTRUCTION .....__ -----------~--~----D Commercial/Multi-Family l D Demolition
D Manufactured Hom ; (Single o ~ Multi-Level)
: ~ Resi l entl al-iSF,D upi ex or Tow nho ~~ · _OJ_D_ Reroof
i INVOLVED PARTIES -]
~rtv Owner: _-__./--'/_l'f __ M.....,.'?f,,_-_~_'L..c.7_S ________ Phone: ( z~ ) 41 (, -93-/ ~ j
, M~lingAddress:_~~8~~~~~d~~~~~~~'-~~~~~~~~~J~~~-~~~~~~-~-~---~
; Contractor: A'Q£lJt/L fo;..1e ~-;-~ Phone: ( t/"10) z.t/z. -g~?p?
~ M~lingAddress:_~-~-~-~-~_h_~_S_~~~-'-~--~~~-~-~---~~~-~~~~~~~~~=~~~~e~~~~~~-~_D_
l Architect: _________________ Phone: ( _______ _
l Mailing Address: __________________________ _
Engineer: _________________ Phone: ( _______ _
Mailing Address:---------------------------
Manufactured Home Installer: ___________ Phone:( __ ------
Mailing Address:---------------------------
PROJECT NAME AND LOCATION
Describe Work: ___;:;6.:....;;z::....:~...:..::::....0€:::...L...__,_~....;.L..:;....;...;M'----l_';:?J'-j!)-J_,e-'----~-o_'_x_~_t:J_' __.;;;.~__;,,/J-..;....;..;;i3 ....... ----'6.'--~....;;._?_r
/0' i3v1?01rlt. Z K ~ &u .sr~vc/liJ,J
Job Address: _z__.~_8'_3 __ e_~_~_o_l ___ -_"FA_~_'.l?i_~_WzJ._/'E ___ <J_lt_3_.5 ____ ---;
Assessor's Parcel Number: Sub.--------Lot __ Block __ 1
Owner's Valuation of Work:$ ~ e:£t,rQCJD ,_00 Property Size (Sq. Ft. or Acres): _!._'O_I/._~_.....;
Sq. Ft. of Building: ~00 IF Height: I 0 'eJn-1-# of Floors:. _ _.;_/ __ _
Class of Work: I ~ New I D Alteration 1 b Addition 1 D Repair D Move/Relocation
....J.
1 J[oetached
~ -I D Community
D Electric
1 Garage:
l
: Septic ~ !'(µ
Type of Heat:
' D Attached
jO OWTS
I -D Natural Gas D Propane --,-D Other -
oPer"mit n: ______ _ -Driveway Permit: D Exempt
...._ __ _ J
NOTICE r
~
Authority. This application for a Building Permit must be signed by the Owner of th~ property, described above, or
I
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
I purposes of inspections by the Building Division .
Other Permits. Multiple separate permits may be required : (1) State Electrical Permit, (2) County OWTS Pe rmit,
(3) another permit required for use on the pr operty identified above, e.g. State or County Highway/ Road Access or
a State Wastewater Discharge Permit.
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.
CERTIFICATION
~~ -~~~~~~~~
I hereby certify that I have read this Application and that the information contai ned 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 th is Applicat ion, a Building Permit will be issued granting
permission to me, as Owner, to construct the structure(s) and facil ities detailed on the submittals rev iewed 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, OWTS
regulations and applicable land use regulations (County Regulation(s)). I ac knowledge that the Building Permit
may be suspended or revoked, upon notice from the County, if the location, constructi on 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 permi ssion to the Building Division to enter the property, described above, to inspect the work. I
further acknowledge that the issuance of the Bui lding Permit does not prevent the Build ing Official from : (1)
requiring the correction of errors in the submittals, if any, discovered after issuance; or (2) stopping construction
I 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
l constitute an acceptance of responsibility or liability by the County of errors, omissions or discrepancies. As t he
Owner, I acknowledge that responsibility for compliance with federal, state and l ocal laws and County Regulati ons
rest with me and my authorized agents, including without limitation my architect designer, engineer and/ or
builder.
have provided the requir.
nd the Notice and Certification above, as well as,
ect and accurate to the best of my knowledge.
tJ~;&k
I I
Property Owner Print and Date
OFFICIAL USE ONLY ·' ·-~ " ----
--~
Special Conditions:
/t/f'tLwe.r/ ~ uxheAle~ llCa'rfo/llf lo "1>1d111ltA! U?e >~t .. lure .
Adjusted Valuation: Plan Check Fee: Permit Fee: Manu home Fee : Misc Fees:
36~«;a . -?Z-6 .5? 5oZ .?5 NI t\ -
Total Fees: Fees Paid: :3 Balance Due: BP No: OWTSNo:
8-z e. 88 1>::IJ..~.:s so-z... ~5 ~ u t:" -'?-11RA ~Jn
Setbacks: OCCGroup: Const Type: Zoning:
I .£/ZC. J/ZC-r'Z~~5/I) 'R
~.e~<./~¥~ ~tB~f BUILDING / PLANNING DIVISION : ; I
Signed Approval Date