COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
APPLICATION FOR PERMIT TO BUILD
FOR OFFICE USE ONLY PERMIT NUMBER:
___ GAMMA
___
FOOD H
ANDLING
___ ASSESSORS FORM
___ FIRE DEPARTMENT
___ ASSESSORS FLOOR PLAN
___
GREASE TRAP
___ SPECIAL INSPECTION FORM
___ PLANNING
___ CROSS CONNECTION
___ SANITATION APPROVAL
___ PUBLIC POOL
IT IS THE RESPONSIBILITY OF THE PERSON OBTAINING THE PERMIT TO DELIVER ALL
CLEARANCES AND APPROVALS TO THE BUILDING DEPARTMENT OFFICE.
VALUATION: $_______________ PERMIT FEE: $____________
PLAN REVIEW FEE: $_____________ ܆܆ PAID ܆܆ UNPAID
TO BE COMPLETED BY APPLICANT
THE APPLICANT MUST S
UPPLY THE LICENSE IN
FORMATION
FOR
ALL TRADES LISTED BELOW PRIOR
TO PERMIT ISSUANCE
SUB-CONTRACTOR INFORMATION
PLUMBING CONTRACTOR:
STATE
CONTRACTOR #:
: LOT: BLOCK:
GAS/ HVAC CONTRACTOR
:
OWNER
STATE CONTRACTOR #: ______________________ -OR-
CITY OF GJ LICENSE #: ______________________
ADDRESS:
ELECTRICAL CONTRACTOR:
STATE CONTRACTOR
#:
MESA COUNTY USE TAX
ARE BUILDING MATERIALS TO BE PURCHASED OUTSIDE MESA
COUNTY?
܆
܆
YES
܆
NO
IF YES, CONTACT MESA COUNTY TREASURER 970-244-1824
DESCRIPTION OF WORK PLANNED
PROJECT SQUARE FOOTAGE:
ACKNOWLEDGEMENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND THE ABOVE IS CORRECT AND I AGREE TO
COMPLY WITH ALL CITY/ COUNTY ORDINANCES AND STATE
LAWS REGULATING BUILDING CONSTRUCTION.
SIGNATURE:
-- FOR OFFICE USE ONLY --
APPROVAL DATE: PLAN REVIEWER:
INSPECTIONS?
SPECIAL CONDTIONS:
-
200 S. Spruce Street PO Box 20,000-5005 Grand Junction, Colorado 81502
Telephone: 970.244.1631
Fax: 970.244.1769 www.mesacounty.us/building
Version 3/2020