HomeMy WebLinkAboutApplicationGørfteld CountyERECEI
,ÀllË i fi Cpfr{$unity Development Department
108 8th Street. Suite 401
F.î'i5'iFi3'u',?o\Èffiüî;fi ',ïï#81601
www.Farfi el d-cou ntv.com
BUILDING PERMIT
APPLICATION
ryPE OF CONSTRUCTION
Com mercial/M u lti-Family Demolition
Manufactured Home (Single or Multi-Level)
Residential (SF, Duplex or Townhome)T Reroof
Accessorv Dwelling Unit (ADU) - MAXIMUM SIZE OF 1,000 SQUARE FEET
INVOTVED PARTIES
Property Owner:
Mailing Address:
Email Address:
C Alùrnon"q\,r3
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Contractor:
Mailing Address:
Email Address:
ó
Architect: Phone:
Mailine Address:
Email Address:
Engineer Phone: ( )
Mailing Address
Email Address:
Manufactured Home lnstaller:Phone:
Mailing Address
Email Address:
PROJECT DETAITS
Describe Work:c,f,{
t ;/hqf!(
Job Address:S
Assessor's Parcel Number:
Sub.Lot Block
Owner's Valuation
Sq. Ft. of Building:
of Work:Property Size (Sq, Ft. or Acres):
Height:f¿N # of Floors
prN)ó\
¡(¿Ò
Class of Work:New Remodel/AlteratioltJ Addition
Garage:Attached Detached
/)ru4
OWTSSeptic:
Electric OtherPropaneNatural GasType of Heat:
Driveway
Permit:
PROJECT DETAITS CONTINUED
NOTICE
Authorlw. This application for a Building Permit must be signed by the owner
or an authorized agent. lf the signature below is not that of the Owner, a sepa
Community
Permit #
of the property, described above,
rate letter of authority, signed bY
the Owner, must be provided with this Application.
LeFal 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,
1i¡ anottrer permit required for use on the property identified above, e.g. 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 contai ned above ¡s 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 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, 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 e ineer and/ or builder
I hereby acknowledge that I have read and understand the Notice a nd Certification above, as well as, have
provided the required information which is correct and accurate to the best of my knowledge'
i ú"^1,,v,,,ü,ru t;"*g
Property Owner Print and Sign ¿ H/-jA l-Date
Qa\d e/r k/rq Qtnn oo J+ Mf{aoFFrclAL usE oNtY
Special Conditions:
'i5Manu. Home Fee:
N\lv\
Plan Check Fee:fr\)A '¿lä'å:"sbAdiusted Valuation:'rÙ I r+
OWTS Nor
Ð\A"'s61m BP Nb:
ø(ffiF-,gðß'"$ififr. o'Total Fees:$loo.0o
Zonins:çr3."5PLOCC Group:TQC-Setbacks:\)lA
BUTLDtNG / PLANNING DIVISION :
Signed Approval
I
Date