HomeMy WebLinkAboutApplication+ECVI�+
FE,3 t 9 Gay-fzeld County
108 8'a Street, Suite 901, Glernvood Springs, CO 8!607
GARFIELD COUNTY Ph:970-945-8212 Fx:970-384-3440 /nspection Line:888-868-5304
BUILDING & PLANNING www.¢arfield-countv.com
BUILDING PERMIT APPLICATION
1
Parcel No: (this information is available at tire assessors office 970-945-9134)
Lot No: Block No: Subd./ Exemption:
2
Job A dress: (if an address has not been .1 red, please provide CR or e t Name & Ciry) ore egal description
Adjusted Valuation:
,Sen e- c ClJ ! SO
3
wner. (pr
rly
mer)
Mise Fees:
ilio Ad ss:Ph:
3p' 5, t Ph:
Balance Due:
BP No & Issue Date:
Raw-- -38A
ISDS No & Issued Date:
Setbacks:
OCC Croup:
Const Type:
Zoning:
BLDG T:
a p ,
/
4
ontractor:
Mailing Addre se
Ph: Alt Ph:
5
Manufactured home installer:
Mailing Address: p�'�
Ph: Lie #:
6
Architect:
Mailing Address:
Ph: Alt Ph:
7
Engineer:
Mailing Address:
Ph: Alt Ph:
8
Sq. Ft. of Building:
Sq. Ft. or Acres of Lot: n
Hight: No. of Floors:
9
Use of Building:Class
of Work:
esidential OCommercial OOther
ONew OAltemtion OAddition pair ODemo OMove
10
scre W
`
f40Q KA -c-
11
G a e:
Septlb:
Type of Heat:
LA Attached ODetached
OISDS OCommunity
ONat. Gas OPropane OElectric OOther
12
riv way Permit:
Owners valuation of Work:
NOTICE
Authority This application for a Building Permit must be signed by the Owner ofthe property, described above, or an authorized agent. If the signature below is not that of the Owner, a sepemte
teller ofa al only, signed by the Owner, must be provided with this Application.
Least Access. A Building Permit cannot be issued without proof of legal and adequate access to the property for purposes of inspections by the Building Department.
Other Permits. Multiple separate permits may be required: (1) State Electrical Permit, (2) County ISDS Permit, (3) another permit required for use on the property identified above, a g. Slate or
County Highway/ Road Access or a State Wastewater Discharge parmil.
Void Permit. A Building Permit becomes null and void if the work authorized is not commenced within 180 days ofthe date of issuance and ifwork is suspended or abandoned fora period of 180
days after commencement.
CERTIFICATION
I hereby certify [hat 1 have read this Application end that the information contained above is true and correct. I understand that the Building Department 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.
Assorting completeness ofthe submittals and approval of this Application, a Building Persil will be issued granting permission to are, as Owner, to construct the structure(s) and facilities detailed on
the submittals reviewed by the Building Department.
In consideration ofthe issuance ofthe Building permit, I agree dial I and my agents will comply with provisions army federal, state or local law regulating the work and the Garfield County Building
Code, ISDS regulations and applicable land use regulations (County Regulation(s)). I acknowledge that the Building Permit may be suspended or revoked, upon notice from the County, if the location,
construction or use ofthe strucmre(s) and facility(ies), described above, we not in compliance with County Regulation(s) or any other applicable law.
1 hereby grant permission to the Building Department to enter the property, described above, to inspect the work. I further acknowledge that the issuance ofthe 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 ofthis Application, including submittals, and inspections of the work by the Building Department do not constitute an acceptance ofresponsibility 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
limiletionm Idagner, engineer and/or builder.
IHE ACKNO GE THATIHAVE READA STAND THE NOTICE &CERTIFICATION ABOVE:
OWNERS SI N UR DATE
STAFF USE ONLY
Special Conditions:
Adjusted Valuation:
Plan Check Fee:
Permit Fee:
Manu home Fee:
Mise Fees:
Total Fees
Fees Paid
Balance Due:
BP No & Issue Date:
Raw-- -38A
ISDS No & Issued Date:
Setbacks:
OCC Croup:
Const Type:
Zoning:
BLDG T:
a p ,
/
PLNG DEPT:
APPROVAL
DATE
APPROVAL
DATE