HomeMy WebLinkAboutApplicationGørfield Countlt
BUILDING PERMIT
APPLICATION. ,.^ Cçm-munity Development Department
,AU6 I I Zülfross,hstreet,suite4ol
GARFIELD C€lfNfTod springs, co 81601
c0MMUNITY DEVELOpMENteTO) s4s-8212
www rfield -com
WPE OF CONSTRUCTION
DemolitionIti-FamilyItlManufactured Home ngle or M ¡RerooforResidentialDu
INVOLVED PARTIES
Propefi Owner:
Mailing Address:
Phone: ,o?retJl? - á¿/Zt 7
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Email Address:
Phone:
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Contractor:
Mailing Address:
Email Address
Email Address:
Phone:ll
Mailing Address
Architect
Email Address:
Phone:ll
Mailing Address:
Engineer:
Move/RelocationRepairL,.lRdd¡t¡onf l aheration! wewClass of Work:
DetachedAttachedGarage:
Manufactured Home Installer:Phone:
Mailing Address:
Email Address:
PROJECTÐETAIIS
Describe Work:
Job Address t
Assessol's Parcel Number
Sub. Lot- Block-
Owne/s Valuation of Work: $Property Size (Sq. Ft. or Acres):
5q. Ft. of Building:Height:# of Floors:-
[-lo*r"tflElectr¡cPropaneNatural Gas
U
Type of Heat:
Driveway Permit:Exempt Permit #:
NOTICE
Authoritv.I Jrrs pplicatlon for B uil tJing Pe TM it must be signed by thc Owner of the pro PertY,described above,
an authorized agent.rf the signature below ls n ot that of th e Own €f,a scparate letter of uth ority signed byor
the Owner, must be provided with this Application'
Legat 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'
bther perm¡ts. Multiple separate p"rritr 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 AP plication 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
comp leteness of the submittals and approval of this Application,a Building Permit will be issued granting
pe rmission to me, as Owner, to construct the structure (s) and faciliti es 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 regul ations and applicable land use regulatio ns {County Regulation(s)). I acknowledge that the
Building Permit m ay be suspended or revoked, upon notice from the County, ifthe 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 perm¡ss¡on to the Building Division to enter the property, described above, to inspect the work' I
further acknowledge that the issuance of the Build¡ng Permit does not prevent the Building official from: (1)
requiring the correction of errors in the submittals, if any, discovered after issuance; or (21stopping
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
d ner, engln eer and/ or builder
PROJECT DETAITS CONTINUED
Septic:OWTS Community
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
provided the required information which is correct and accurate to the best of my knowledge'
TacTu d-l;n¿ ô"nr,e+þ
Print and Sign Date
OFFICIAT USE ONLY
Special Conditions:(æ-l8 ü*-
Misc Fees:Fee:Fee:æFee:PlanAdiusted Valuation
Balance Due
CIoT6
ZonConstocc G
n
BUILDING / PTANNING DIVISION
Signed Approval