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, --- --Qommunity Development DepartmentRECEIVED 1o88th street, Suite 401
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ComNurulrv DEVELoPMENT
WPE OF CONSTRUCTION
l--l Commercial/Multi-Fam
rNvowED
! Demolition
Gurfield County
BUILDING PERMIT
APPLICATION
fl Manufactured Home (Single or Multi-Level)
I ReroofI Residential (SF, Duplex orTownhome)
Property Owner:
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Mailing Address:
Mailing Address: ¡ I ft4
Emaif Addrest, kV 4Ëtu*T4l¡vs 6J q ¡Mt.'4íL , La/u"l
Architect: '# phone:
Email Address
Engineer:Phone: I
Mailing Address:
Email Address:
Manufactured Home lnstaller:Phone:
Email Address
PROJECÍ DETAII.S
Mailing Address:
5 E uf + JëRÊ/¿1Y,4// k/¡+rxtuSContractor:
H t"r."
Phone: ( /4Cì I 297 t95?
Mailing Address:44 N*uNo ST Nøt*, (ks'rte Ct)
Email Address , JÉR"Etvlf/+H"""t(Ð é, /þ14/L , (L\M
ê,47
I Rlteration I Repair | | Move/RelocationClass of Work:! ruew
Garage:
Assesso/s Parcel Number
Describe Work:R r¿c.e.
Job Address:àt 4rrL{
Lot _ Block _
Property Size (Sq. Ft. or Acres):
/ 2 -AcJ *ot
Sub.
Owner's Valuation
Sq. Ft. of Building:
of Work:
Attached
Height:
Addition
Detached
.2é,2 a
I
t
PROJECT DETAII.S CONTINUED
Septic:OWTS
Type of Heat:Natural Gas
Driveway Permit:n Exempt
Propane
Community
Electric
Permit #:
Other
NOTICE
Authoritv. This application for a Building Permit must be signed by the Owner of the prope
oranauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterof
rty, described above,
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 Perm¡ts. 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.
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 contained 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 this Application, a Building Permit will be issued granting
permission to me, as Owner, to constructthe structure(s) and facilities detailed on the submittals reviewed by
the Building Division. ln 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 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
hereby acknowledge that I have read and understand the Notice and Certification above, as we¡l as, have
the required i which and accurate to the best of my knowledge.
Property Owner Print and Sign
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oafe /
OFFICIAL USE ONTY
Special Conditions
Misc Fees:Perm¡t Fee:öl oo, oo Manu home Fee:Plan Check Fee:Adjusted Valuation:
BP NorTm( s¡?"OWTS No:Fees Paid:
ıl oo.oo
Balance Due:
Ð-
Total Fees:
#toD.ÒÒ
Const Type:Zoning:
L\r^tt?
OCC Group:Setbacks:
BUILDING / PLANNING DIVISION
Signed Approval
oilp/ g
Date
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