HomeMy WebLinkAboutApplicationGarfield Countyl{b:il
r : , Crnnmunþ Development Department
mB E3 Street, $¡ite ¿t{11
f,'t^i I' m * iÊ"nn\goYn o"..o 81601
uvww:ærfieldfgg¡SLcom
tNvowED
Unit {AOU}: MAXIMUM SIZE OF 1,200 SQUARE FEET
Demolition
Gas Piping
Reroof
Phone:17*NProperty ourner:
MailingAddress:
Email Address:
5¿
Contractor:Phone:
MailingAddress:
Email Address:
BUILDING PERMIT
APPLICATION
Manufactured Home {Sinele or Multi-Level)
Residential or
I
I
PRO¡ECTDETruU¡
flescribe Wo¡k:
JobAddress:
Assessol's Parcel Number:
Sub.Lot Block
Gas Pipe tenßü/ Diameter:
Applhnces Serviced By 6as Line {list all, indude BTUf:
Alteration I Addition
fnr"tur"t Gas Propane
Classof Work:ß"*
flpe of Heat:
NOTICE
Authorlty. Thls appllcatlon for a Bulldlng Permlt 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.
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.
QthglSegn¡ts. Multiple separate permits may be required: (1) State Electrical Permit, (2) County OWTS PermiÇ
(3) another permít required for use on the property identif¡ed above, e.g. State or County Híghway/ Road Access
or a State Wâsteweter Discharge Permit.
vp!dlCU!!-A Building Perm¡t 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.
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
perntission [o rne, äs Owner, to construct the structure{s) and facllltles detalled on the submittals reviewed by
the Bu¡ld¡ng 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 Garfìeld 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 herehy grant permission to the Building Division to enter the property, described above, to inspect the work- |
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 en acceptance of responsibility or tiability 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 arch¡tect
designer, engineer and/ or buÍld
I hereby acknowledge ave read and understand the Notice and Certification above, as well as.
have the which is and
Prlnt and Date
OFF¡CIAL USE ONLY \
Special Conditions:
Adjusted Valuation:
N/A 'i'ä"po Misc. Fees:
Total Fees:
l"oQ .""Fees Paid: ^zà\co v"Balance Due:
å/'ffivxçøK Zoni4g¡
V<
q-þsS
Date
BUtLDtNG / PtANNTNG DTV|S|ON
Slgned Approval