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Com mu nily-pevelopment Department
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BUI¡-DING PERIV¡IT
APPl"]CATION
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DemolitionCommercial/Mult¡-Fam
Manufactured Home eorM
T Reroofex or TownhResidential
Dwelli Unit - MAXTMUM SIZE OF 1,200 FEET
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Email Address:
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Mailing Address:
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Phone:Contractor:
Mailing Address
Email Address:
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Architect:
Mailing Address:
Email Address:
Phone: ()
Engineer: Phone:
Mailing Address:
Email Address:
Manufactured Home tnstaller: Phone:
Mailing Address:
Email Address:
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PROJECÍ DETAILS
Assessor's Parcel Number:
Sub. Lot
-Sq. Ft. of Building: Height:
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Owner's Valuation of Work:
Describe Work:
Job Address:
# of Floors:-
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Block
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Property Size (Sq. Ft. or Acres):
ditionRemodel/AlterationNewClass of Work:
DetachedAttachedGarage
llSeptic:
Type of Heat:
Driveway
Permit:
PROJECT DETAITS CONTINUED
Community
Natural Gas Propane Electric Other
Permit #;
NOTICE
Authoritv. Th is 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. 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 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.
Vold Penflt' 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.
CERTIFICATION
I hereby certify that I have read this Application and that the information conta¡ned above is true and correct. I
understand that the Building Division accepts the Application, alongwith 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 wlth 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 requiring a permit, except for
residential 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 not¡ce from the County, if the location, construction or use of the
structure(s) and fac¡lity(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 designer, engineer and/ or builder.
I hereby acknowledge that I have read and understand the Notice and Certification above,as well as, have
provided the uired information which is correct and accurate to the best of my knowledge.
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Property Owner Print and Sign Date
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c-c_,OFFICIAT USE ONLY
Special Conditions;
Adjusted Valuation:Plan Check Fee:Permit Fee:\oo.oo Manu. Home Fee:Misc. Fees
'lää'.cro cÊ)Fees Paid:lclo Balaþpue:BF tïo:6p83sa 0WTS Nor
Setbacks OCC Group Const. Type:Zoni.qg:
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BUTLDtNG / PIANNING DtVIStON
Signed Approval Date