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Home My WebLink AboutApplicationGurjield County BUILDING PERMIT APPLICATION-- ¡ÉFr Community Development Departmênt REGÉNru rog s,h streét, sutte 4ol E Comme Demolition Manufactured Home le or Multi- Residential , Duplex or Townhome)Reroof INVOTVED PARTIES Property Owner: Mailing Address: è'r v.ûL(Q Phone:?7,t .î73 6 .le-{LCl\ Email Address:'îå'L(a "^ Manufactured Home lnstaller: Phone: (-)- Mailing Address: - Email Address: PROJECT DETAIIS Describe Work:e Job Address: Assessol's Parcel Number: Sub.Lot Block Owne/s Valuat¡on of Work:Property Size (Sq. Ft. or Acres): Sq. Ft. of Building:1rO1,Height: Class of Work:Repair Mailing Address: Email Address: Phone:Õ \t\,(..f Phone: ú1otVt6 o6So Contractor: Architect: Mailing Address Email Address: Phone: ,4?o ,1.$- 6boî Mailing Address:. Email Address: Engineer: Garage:Attached Alteration Addition fof Detached Move/Relocation I pno¡rcr oerhrs conr¡nuso - Septic:É"*t¡!Community Type of Heat:Natural Gas Propane Electric Other Driveway Permit:Exempt Permit # NOTICE Authoritv. This application for a Building Permit must be signed by the Owner of the property, described above, oranauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedby 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 permits. 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.8. State or County Highway/ Road Access or a State Wastewater Discharge Permit' VoidPermit. ABuildingPermitbecomesnull andvoidiftheworkauthorizedisnotcommencedwithinlS0days 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 an d 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 construct the 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, construct¡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 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 neer and/ or builder I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have provided the required Owner Print and Sign information which is correct and accurate to the best of my knowledge.# r/zÕ /tu/r Date , OFFICIAT USE ONIY Special Conditions: Ðo. lulxcT Manu home Fee:Misc ,oè5PermitFee:Ito43,3;Adiusted Valuation2)5. nl ww:ib ifxe"rqçr OWTS No:w5¿lgglozl-oL Fees Paid:Balance Due: -tb77 47 Total Fåes: z1 t1.51 ConstTvoe: ^: -=:fic Zonihg:R*YKL r-{Setbaeks: BUITDING / PLANNING DIVISION Date lD ôþ 70 fc rê-ø: tsuitdÍns.l T,smins P lan Review Checklist perrnit Number: Þ qE- 53Af )rn S*ss Buil Plannincl Zoning Engineered Foundation Property Line Setbacks I ^(. ay Permit Site Plan and Setbacks Gra Topography 30% Attach al Plan Review List t/A 30 ft. Stream Setbacks Al,'l Flood Plain D./L,Building HeÍght ning Sign-Off bdivísion Plat Notes Fire Department ReYíew /^Á luation Determinatíon/ Fees 0), ^. . Road tmpact Fees N"ÇWZ*', 4adel Topogr aphy 40% Planning lssues Subdivisíon Plat --Å/-ùq0# snowloa d Lette r - Man u. Homes./ V soils Report Plans/ Stampsl Sticker Attac ons App tion Signed Revíewer to Sign Applicatíon Parcellschedule No General Comments: C.S. 2oz9 v lE /^tott n, 2>ZS + 74 Gnaa 642 r 9z C fu.¡t 4L þ ts = 36144 -g-9 - /51,o77. a/ : 26r?41 2/5t/îl