HomeMy WebLinkAboutApplicationGorîwúi Coanl¡r
comrunitty Deúcloprt€llt frcp.rültctlt
fg$st¡ect Ss¡E4Ol
G¡lemood Spfu5; COüml
$relr'i|¡wtz
rrr,¡¡ffdd-or¡nür.sn
lñdlamufacft¡rned üfo'nne (Sin6lle on lMullûii-tewll)
Residernrtiiall {Sf, Du¡dlet on Tomnlhonrc}
[-ll ncæççony Dwlllliing tlJlnriü {ADU} - mÁnmut JIZE OF 1P0O JqftARC fEEf
HW.trE ,-**.-.:--r-*.* -,-,
Plo¡ertVOnnr
ilfiçlddrcs:
E¡rnil¡lddres¡;
Phæ:
Conù-¿ch
HaúrgÁdterr:
^rútEcËllaif:rglddror:
EmilAddræ
Er¡frt Êr
llaiÍrgÁddren
Effilddtæz
Hanr¡frcûncd lþme ¡rteã:r:
Haftf Adûc¡¡:
ffiffiæ
work
rlobåddlcs:
i âserror'¡Í¡rrcl fürmücn 2l8l alL
lsu¡- 6r'(c^rt f
Omer'¡Val¡albt ofWorkS
S+¡t dlufdftl:|.z3z
kopsrtf gre lSq. fi" or¡lcre lE l,lqL
tof fuis=-l
Phon :
Plnn:{}
Phonc:
Pln::
rl
t
(o çbql
? ôol
rot I sncr
rl¡rcof Work
BU ILDING PERM IT
APPLICATION
,ntvfl/f--\
6rrqp:âuectrcd
H€úe
[þtrh¿d
pnilEf
Scpúc:
TW.of ficet;Propane
mttrrf
ffi
nnhodtr" flhlr ap$ikation for a Euilldiilg Pqrnnilt nnust he sftn€d bf ühe Owncr d ftc property, descr[ùed aüoue,
orana¡tll¡oriizodaßiemt üftft€gÊlrlaHÍrebdlûwi6tno't$atofül¡eOrynen"asepardel€ítercfaud,roíiity.sfgnedbf
ülre Oumer, rmust be foui¡led ryith ffiús Appllkation"
l¡ld læe¡' A EuiHäng Pem¡t camnot be hs¡ed wfiûll¡out proof of t€gal¡ arnd adoquæ acress to tÍîe prop€rty fur
purpøes of fnspeatforr hy the Build¡rrg Di¡ui-rdkm"
Olhcr Ènnå¡. fríuhipile separdüe pcflnôts írãy be requ¡ined: (ü State Ëlecnrica¡ pcnnit Fl Counry üirTS pennít,
(3f arnodnr penrnllt req¡¡ired fur use m llhc prroperty Ídenüiffied ahoæ, e*g Stile or Canrûy HEfilrayl n6d å@sF
or a Sbþ Wffir Diisciraße perìnÍjt,yd Emtt A Euiildirqg Pennit heomes mulll ild lmfid Írf ttre çlort autlprfted b not omr¡enæd wittrin r^g' da¡s
of the date of ii¡n¡ance amd iif worfle Í*s ¡r¡ryerded orr aben¡dorrcd for a perriod of Il0 dry after æmrÍ€næn¡3rrt-
lci*ri,t.
Gat
I lherefu certüfy ültrat tl hrue ro, X¡r¡¡5 f,ppll*catik¡rm ar¡d tlrrat ülhe iinformatä,om conüaiinred abore b tr¡¡e arr¡d correcL I
u¡tndersüand üt¡at tÍ¡e &¡Élldäng Dftriiriloflr acteFús üine Applliirationn, abnrg wütfi ühre plðn$ ánd specijficatirons and rl$¡en
data $ibmiitted hy me or om nry beltnallf {srhrnirttalb}, based aryon nrrrry oenffifficaüilom as b accuraay. Asstnmä,rry
@'rmpilctem€ss of th,e subrmittalb arnd apprrovall of üib Applkãtion, a Erlrilldiiry Fenn¡t wflll be ñss¡¡¡ed grðntirTg
penmüsskm to ñtre, as Oüilìer' b cor¡st¡ru¡d rhe süructure(s| amd facillltkx deùaílled om dlne subn*ttah rreuúewed by
tfin Bruilldiilrç Oivbiom" ln ondideratíorn of th€ iissuance ûf d¡e !'uilldäil'S Fe'nmÍq I agrge ü¡at I and nry agents w¡lü
complþ wftllt pnwiisions of any federaÍ, staüe or llocall llæ rregulflating ühe rcnflr and ür€ Carfrdd Cour¡ty Buúlding
Code, Otltll5 regu¡futiofls and appllbhåe hmd usp nqullatúons (Courmy neguüetiür{s[" I acførornrfedge ütet fhe
fuiilldirng psnrniit may be suspendcd or rrercked, upom nntiroe from tt¡e Coumtl, ¡"rf tffre lloc¡tir¡m, constn ctbn or use
orf tllïe stnuclurre{s} and facít¡ity(iþr}, d€scribed ahoru, are not ¡n roímpllana witir Cournty Re$¡ilãtÍon{s} ora¡¡y
ortÍnerapplkehh üarr,
I lhereby gramt perrrnibsñon üo ttre Suifdinrg Diirrürorn to entertltre pnoperç descnlbed ahow, to ¡ßp€cù üe rcil{r" ll
it¡r$enacfuowÌedeeüâtdreÍsei¡amceof tllp BuilHing Fermltdoesnot proænttfie Buíldngofficialftorm: {lf
reÇliirfilry d¡e correatijrm of errors in üt¡e suhmitüellr, ûf amy, diiscoræred afrer bqnnoq or (21 ¡topp¡ng
aomsûruatirorì orr use of the stn¡cù¡r€(sl or faú¡liffiiesf if üuú is im u*ofi¡tñoû of Coqrrry neubtion{sf or any odrer
appliicahlh llmu" ßc¡tw of thís frppllñcatìion, ändludftng slhmittallç, and irspecilibnm of rhe wo* þ the Builldiirng
DiMisiñom do r¡ot cori$ü¡itute am äcûepùãnce of n'espomiibiitûty on liahflliiuy b^y the Cou¡mty d enrors, orniissions or
dilrrrepamcrÌes- As tlhe Owner, I adknrr,owll@e ühat nespornsihÍüity for eonnplñamce wútft feder¡lL rtarte and toca6 lâffi
and Coumty Regü'üatik¡lnf re$wfüt! nmeamd
deSägneç etryrìrmeer alrd/ or hliìlder"
nry auülhoriizcd qent$, imdudiry without fimlitatii'on nnry arcfrrtfect
I lËrury eúrdrdgç drnt I h¡n rr€d and und:r¡ttd ú. ilofu ad €ertiñcaüon &Ç, er læl eq lnn
ptottid¡d ürc rcç¡ind tuifornradon shidl b ørcct and aø¡ræ toüp ú
Pritt m
Comnrumify
E¡cctr¡c O$cr
Permltüf
fpcd¡lConûíms
áfirrûcdVahdon:fbnû.rtfæ:ElttdtFêC'Í¡ru,1hñahct¡l/'+ilÈc.fcc*
fotal Fcc*Fcc¡ P¡H:
*roo.oo
ta*rnacDç;f lPto:
FooF-727L
OUTSto:
NA
SÉ{bá*:*n*i
r?.c.Con¡LTWe:
1. r". c.Zñ;ll
PvrTA L
tulDtre/Hatrtr6
ûil.