HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212 .
www.garfield-county.com
I TYPE OF GRADING
D MAJOR
INVOLVED PARTIES
'-· ~::::~;D£:_~ Property Owner: \
I D MINOR
Phone: ~)~?Cf ~ '-/?
Mailing Address : fl}? '1 &7 ('2 q50 252:> ~)
Contractor: s ~ Phone: ( )
Mailing Address:
Architect: Phone: ( )
Mailing Address:
Engineer: Phone:( __ )
Mailing Address :
PROJECT NAME AND LOCATION
Project Name: C)(_JJ IV~ (-,~ ""v\ \ 1-v \..._ \:::::a~~ )
Describe Work: E-x -L· ... rr-c> /?__ ~r-\'\Su--> vV\0DUL.AZ
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Job Address: ·1 rs·1 2-~0 ~ $1 ~
Assessor's Parcel Number: 2-t '2-§3 J lf DO o ~-o
Sub. Lot Block -
Earthwork (square feet): ~O .06 Earthwork (Cubic Yards):
ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
NOTICE
Authority. This application for a Building Permit must be signed by the Owner of the property, described above, or
an authorized agent. If 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 le ga l and adequate access to the property for
purposes of inspections by the Building Division.
Other Permits. Multiple separate permits may be required: (1) State El ectrical 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 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 contained above is true and corr ect. I
understand that the Building Division accepts the Application, along with the plans and specifications and other
data su bmitted by me or on my behalf (submittals), based upon my certification as to accuracy. Assuming
completeness of the subm ittals and approva l of this Application, a Building Permit will be iss ued granting
permission to me, as Owner, to construct the structure(s) and facilities detailed o n the submitta ls reviewed by the
Building Division. In consideration of the issuance of the Building Permit, I agree that I and my agents will comply
with provi sions 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)). 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 la w.
I hereby grant permission to the Buildin g Division to enter the property, described above, to in spect the work . I
further acknowledge that the issuance of the Building Permit does not prevent the Building Official from : (1)
requiring the corr ection 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 thi s Application, including su bmittal s, and inspections of the work by the Building Divi sion do not
constitute an acceptance of responsibility or liability by the County of errors, omission s or discrepancies. As the
Owner, I ack nowledge that responsibility for compliance with federal , state and local laws and Co unty Regulations
rest with me an d 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 required information which is correct and accurate to the best of my knowledge.
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Property Owner Print and Sign Date
OFFICIAL USE ON~ Y
Special Conditions:
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Permit Fee : qP!..,
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Misc Fe es: Total Fees:
$ ~
Balance due: Grading Permit:
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BUILDING/PLANNINGDIVISION 4 ~~
Signed Approval
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Fees Paid:
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Zoning:
I / Date