HomeMy WebLinkAboutApplicationGurfield CountyRECE
Community Development Department
108 8th Street. Suite 401
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(970194s-8212
www.garfield-countv.com
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BUILDING PERM¡T
APPLICATION
TYPE OF CONSTRUCTION
Commercial/M ulti-Family T Demolition
Manufactured Home (Single or Multi-Level)
r\^/îesidential (SF, Duplex or Townhome)Reroof
Access Dwelli Unit - MAXIMUM SIZE OF SQUARE FEET
INVOLVED PARTIES
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Phone: ( q'ß )36 I -Ss -?¿o-q¿1b'-ìno.,..
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anò Phone:
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Contractor:
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Property Owner:
Mailing Address:
Email Address:
Mailing Address
Email Address:
Phone: (Architect:
Mailing Address
Email Address:
. Phone:taZat na4'.iÔoLEngineer:i, tLo+h . 5u'tMailing Address:
Email Address:Co
PROJECT DËTAILS
Email Address:
Manufactured Home lnstaller:
Mailing Address
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Phone
owner,sValuationofWork:s--PropertySize(Sq.Ft'orAcres):
Describe Work:
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Lot
Height:
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fJ, ' ero.r.
Sq. Ft. of Building:# of Floors:
Sub.
Job Address:
Assessor's Parcel Number: Q-l ? -ç i t
Class of Work:New Remodel/Alteration Addition
Garage:ched Detached
\ 631
PROJECT DETAI[S CONTINUED
CERTIFICATION
I hereby certify 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 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, lagreethat land myagentswill
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)). lacknowledgethatthe
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
desi r, en eer and/ or builder.
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
provid ed the requ rmation which is correct and accurate to the best of my knowledge,
/o Jc>
rty nt and Sign Date
CommunityCWTSSeptic
Electric OtherNatural Gas PropaneType of Heatr
Authoritv. ThisapplicationforaBuildingPermitmustbesignedbytheOwneroftheproperty,describedabove,
or an authorized agent. lf the signature below is notthat of the Owner, a separate letter of authority, signed by
the Owner, must be provided with this Application'
Legal Access. ABuildingPermitcannotbeissuedwithoutproofof legal andadequateaccesstothepropertyfor
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.g. State or County Highway/ Road Access
or a State Wastewater Discharge Permit.
Void Permit. A Building Permit becomes null and 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.
NOTICE
ooOFF¡CIAI USE ONLY
Special Conditions:
Manu. Home Fee:\\ IR
Misc.,Fees:\\ /R
Plan Check Fee:
\5 lf}'"d531*Adjusted ValuationNlf\
OWT'S No:
n-\lT-
Fees Paid:flzs oo
Balance Due
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BP No:
Eînn-+fficTotal Feres;$2ı,oo ,wOCC Grouo::ff?(î,Const. Tvpe:
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Setbacks:\)lÈ
,,u:BUILDING / PLANNING DIVISION
Signed Approval
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Date
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