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Gurfield County
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Manufactured Home (Single or Mu 1t¡-tev9!)
Duplex or Townhome)
Unit . MAXIMUM SIZE OF SQUARE FEET
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INVOIVED PARTIES
Property Owner:/,
Mailing e¿¿ress: /é 4¿u,t-rT
(ØÒt/rr- 4732r ¿h áléfzPhone:
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Email Address:.*245,áZ -75.ë t ëa 'zt¿l
: Contrector:Phone: (
r Ma¡l¡ng Address:
' Email Addressl
I Architect:Phone: ( l
r Maillng Address:
ì Ema¡l Address:
Engineer:Phone: { }
r Mailing Address:
ema¡¡Address:
, Manufactured Home lnstal¡er:
PROJECTDETAII.S
Phone:tl
; Mailing Address:
i Eme¡l Address:
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Describe Work:
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lÇfz,/ø*¿ &aø:zr¿e 2g¿l 6 x 5r'-^ù¿- ¿-rzê
r Job Address:/a s ¿zz Zzl .{_rr /.t/u 8/ó{z
; Assesso/s Parcel Number;2^l7ol oât oo6,I 2-
Sub.Lotéê Block _
Owne/s Valuation of Work:
5q. Ft. of Building:
Class of Work:
Property Size (Sq. Ft. or Acres!: ./A .*, Qr,'t)
# of Floorc:-Height:
Addition
Garage:
Remodel/Alteration
Detached
PROJECT DETAII.S CONTINUED
' Septic:
,TypeofHeat:Natural Gas Propane
Community
Electric
i
Other
Permit #:Driveway
Permit:
Exempt
NOT¡CE
Authoritv. This application for a Buildint Perm¡i must be signed by the owner oi ihe property, deiãribet abovà,
or an authorized agent. lf the signature below is not that of the Owner, a separate letter of authority, signed by ,
r the Owner, must be provided with this Application.
lesal 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. Multíple 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 nulland 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.
CERT¡F¡CATION
I hereby certífy 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 thls 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 const¡tute an acceptance of responsibility or liability by the County of errors, omissions or
r 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.
I hereby acknowledge that I have read and understand the Notice and Certification above, as well âs, have
provided the information accurate to the best of my knowledge.
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Owner Prlnt and Sign Date
oFFrcrAt usE oNtY ?å . S I l.{! cß . o! lre lzoZt
Special Conditions:
Ad¡usted Valuation:
iQ.ooo.P
Plan Check Fee:f 8l''lt Permit Fee:sl2,5.o'5 Manu. Home Fee:
r'¡/r
Misc. Fees:
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Total Fees:
tzob,bÒ
Fees Paid:
l7¡ .*t
Balance Due:
* ¡25. Zf BP No:
tsLt(E'¡,-4*l-
OWTS No:
N/A
Setbacks:.N/t OCC Group:Const.
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Type:
tl¿C
Zoning:f¿vräL
7nzlBUITDING / PTANNING DIVISION :
Approval Date
Framing plans for each floor level and roof. All beams, columns, joists, rafters and trusses
specified. Pre-manufactured structures reguire the engineers stamp, signature and date.
Framing /connection details, braced wall lines, shear wall schedule, location and hold downs.
NOTE: lf any required information is missing, delays in issuing the permit are to be expected. lf
determined by the Building Official that additional information is necessary to review the application
and/or plans for compliance, the application may be placed on hold until the required information is
provided. Work may not proceêd without the issuance of a permit.
The Building Division will collect a Plan Review fee at time of application submittal. The permit fee, as
well as any Road lmpact fees will be collected when the permit is issued"
The permit application must be signed by the owner or by person having written authority from the owner
to act as their representative.
Building cannot be occupied until a Certificate of Occupancy (CO) is issued. Using the building without a
CO will be considered an illegal occupancy and may be grounds for vacating the premises. (Final/CO
inspection requirements will be attached to your approved field set of plans.)
I hereby acknowledge I have read, understand and will abide by the requirements of this
eheeklist.
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Property Print and Sign Date
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