HomeMy WebLinkAboutApplicationGørfield County
R Fi (. : Ë.:çr \gllp un ity Devel o pment Depa rtment'"- 108 8th Street, Suite 401
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BUILDING PERMIT
APPLICATION
TYPE OF CONSTRUCÍION
itionCom mercial/Mu lti-Fami
Manufactured Home or Multi-Level
ReroofResidentialF, DU lex or Town
Dwell Unit - MAXIMUM SIZE OF 1,200 SQUARE FEET
INVOTVED PARTIES
Phone:
7
Email Address
Property Owner:
Mailing Address:
ne:Contractor:
Mailing Address:
Email Address:
)Phone:Architect:
Mailing Address:
Email Address:
"À (l0l) 5pq Q.gl
I
Engineer:
Mailing Address:
Email Address:
Manufactured Home lnstaller:Phone: I )
Mailing Address:
Email Address:
PROJECT DETAITS
owner's valuation of work: S â1 O oO Property size (sq. Ft. or Acres):
Describe Work:
5
Lot
313+cues
Height:
Block
# of Floors:_
Sub.
5q. Ft. of Building:
Assessor's Parcel Number:
Job Address:
(AdditionNewRemodel/AlterationClass of Wórk:
DetachedGarage:Attached
PROJECT DETAITS CONTINUED
Septic:OWTS Community
Type of Heat:ural Gas Propane Electric Other
Driveway
Permit:
pt Permit #:
NOTICE
Authoritv. This application for a Building Permit must be signed by the Owner of the property, described above,
or an authorized agent, lf the signature below is not that of the Owner, a separate letter of authority, signed by
the Owner, must be provided with this Application.
lesal Access. ABulldlngPermltcannotbelssuedwithoutproofof legal andadequateäccessrothepropertyfor
purposes of inspections by the Building Division.
Other Permits. Multiple separate permlts 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 nuÍl 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,
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 Perm¡t, 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)). All County development requ¡ring a permit, except for
resldentlal uses, are subject to Article 7 of the Land Use and Development Code. 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.
lherebygrantpermissiontotheBuildingDivisiontoentertheproperty,describedabove,toinspectthework. 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, engineer and/ or builder.
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
is correct and accurate to the best of my knowledge.
tt t1 B
Property ffi, pr¡nt a\o s¡gn Date
OFFICIAT USE ONtY I
Special Conditions:
Valuation Plan Check Fee:
âS¿t,å t 'Tti:""'E Manu. Home Fee:Misc. Fees:
Total Fees:
6{ç- 56
Fees Paid:Balance Due:
Const. Type:
BP No:OWTS No:z5
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OCCGTouR: a,Setbacks
BUItDtNG / PIANNtNG DtVtStON :B-24-21
Date