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Fees Paid & Date:
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Permit Fee:
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Owner: (property owner)
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/Grading Permit:
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Issue Date:
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Building & I nning Dept:
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Mailing Address
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DATE
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GARFIELD COUNTY GRADING PERMIT APPLICATION
108 8th Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970 -945 -8212 / Fax: 970 -384 -3470 / Inspection Line: 888 - 868 -5306
www.garfteld -cou ntv.corn
RECEWE
FEB 2 7 1013
GARFIELD COUNTY
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Parcel No: (this information is available at the assessors o Ice 970- 945 -9134) 'A11'111.11411 I ut_ v ti ,_v j ,. ^ °. .
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Job Address: (if an address has not been assigned, please provide Cr, Hwy or Street Name & City) or and legal description
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I. ;3V. 11 D Block Subd. Exemption:
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Owner: (property owner)
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Mailing Address
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Mailing Address
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Architect / Engineer:
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Sq. Ft. gf'Grading:
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Describe Work:
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UTILITIES SMU LOCATED FXI RTDANY � NCB
Authority. This application for a Grading Permit must be signed by
letter of authority, signed by the Owner, must be provided
Leeal Access, A Grading Permit cannot be issued without proof of legal
NOTICE
the Owner of the property. described above, or an authorized agent. If the signature below is not that of the Owner, a separate
with this Application.
and adequate access to the property for purposes of inspections by the Building Department.
Electrical Permit, (2) County ISDS Permit, (3) another permit required for use on the property identified above, e.g. State or
Discharge Permit.
is not commenced within 180 days of the date of issuance and if work is suspended or abandoned for a period of 180
CERTIFICATION
contained above is true and correct. 1 understand that the Building Department accepts the Application, along with the plans
), based upon my certification as to accuracy.
a Permit will be issued granting permission to me, as Owner, to construct the structure(s) and facilities detailed on the
agents will comply with provisions ofany federal, state or local law regulating the work and the Garfield County Building Code,
I acknowledge that the Permit may be suspended or revoked, upon notice from the County, if the location, construction or
with County Regulation(s) or any other applicable law.
described above, to inspect the work. 1 further acknowledge that the issuance of the Permit does not prevent the Building
discovered after issuance; or (2) stepping construction or use of the structure(s) or facility(ies) if such is in violation of
work by the Building Department do not constitute an acceptance of responsibility or liability by the County of errors, omissions
compliance with federal, state and local laws and County Regulations rest with me and my authorized agents, including without
THE NOTICE & CERTIFICATION ABOVE:
Other Permits. Multiple separate permits may be required: (1) State
County Highway/ Road Access or a State Wastewater
Void Permit,, A Permit becomes null and void if the work authorized
I hereby certify
and specifications
Assuming
submittals
In consideration
ISDS regulations
use of the
I hereby grant
Official from:
County Regulation(s)
Review of
or discrepancies.
limitation
I HEREBY
days after commencement.
that I have read this Application and that the information
and other data submitted by me or on my behal f (submittals
completeness of the submittals and approval of this Application,
reviewed by the Budding Department.
of the issuance of the g Permit, 1 agree that 1 and my
and applicable and use regulations (County Regulation(s)).
structure(s) and facility(ies), described above, are not in compliance
permission to the Building Department to enter the property,
(1) requiring the correction of errors in the submittals, irony,
or any other applicable law.
this Application, including submittals, and inspections of the
As the Owner, 1 acknowledge that responsibility for
my architect designer, engineer and/ or builder.
ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND
NERSSIGNATURE DATE
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STAFF USE ONLY