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BUILDING PERMIT
APPLICATION
TYPE OF CONSTRUCTION
Com mercial/M ulti-Fami Demolition
Manufactured Home (Single or Multi-Level)
Residential (SF, Duplex or Townhome)I Reroof
Dwell Unit - MAX¡MUM SIZE OF SqUARE FEET
INVOLVED PARTIES
Property Owner:
Mailing Address:
Ca)Phone, e)-n tl5/- îSç5
qu Ua
Email Address:I
Contractori Phonet(î)Ò | 274-F6tÒ
Mailing Address: 3I/ 3 e a-<l t.i.</¿< I>.ç.'/+ ? ¿ F/â,c2
Email Address:/ì ?Le )y, t4.tâ *^ .' yt I a s F r't ¿, Ã)- t,*-.'1, I o -tT Wg\J'
Architect:Phone: ( )
Mailing Address:
Email Address:
Engineer:Phone: ( )
Mailing Address:
Email Address:
Manufactured Home lnstaller:Phone
Mailing Address:
Email Address:
PROJECT DETAITS
Describe Work:To^. "l/ ,/È- l?,,nl
JobAddress: I ç l'l tt ar
Assessor's Parcel Number:
Sub. Lot Block _
Owner'sValuationofWork: 5 I 7 I Ô36 PropertySize(Sq.Ft.orAcres):
Sq. Ft. of Building:Height:# of Floors:
Class of Work:New Remodel/Alteration f-ln¿o¡t¡on
Garage:Attached Detached
tl'Septic:
OtherElectricPropaneType of Heat:Natural Gas
I'
Permit #:Driveway
Permit:
NOTICE
Authority. 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 perm¡ts. 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.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 cert¡fy that I have read this Application and that the information contained above is true a
understand that the Building Division accepts the Application, along with the plans and specificatio
nd correct. I
ns 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 Perm¡t will be issued granting
permission to me, as Owner, to construct the structure(s) and facilities detailed on the submittals reviewed by
the Bu¡lding 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
design eer or builder
PROJECT DETAITS CONTINUED
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.
( al/'.t,
Property Owner Print and Sign Dete
6ôuOFFICIAL USE ON
Special Conditions:a I
Manu. Home Fee:r.\ ,Q
Misc.Permit Fee:*lnn. oDAdiusted Valuationñlrn Plan Check Fee:
R,
OWTSrirto:ttlloôôT-Y+túy)
BP No:
$ tôr).oÔFees Paid Balance Due:tó.ØoôTotal Feäs:I ¿ocl.t"ff'Const, TvDe:ilr.OCC Group:120-Setbacks:r\/ A
BUILDING / PLANNING DIVISION :
Signed Approval Date