HomeMy WebLinkAboutApplication-Plansc:8'-Gtufeld County
Community Develapment Department
108 , .. Street, Salte 401
Glenwood Spdnp, CO 81601
1970) 945-8212
www.mflelckaunty.com
--·-·----------· . TYPE OF GRADING
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lNVOLVB> PARTIES
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Contraclor:Xf M~ J ¢---~"'Pk X-Phone:fl70) '".3 .. &""~
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ARNtect:_~--~~~--------Phone:r ___ ~l, ________ __
· MamncAddress: ______________________ _
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Englneer. _____________________ Phane:f~-------------
MaDlngAddn!ss: ______________________________________ __
: PROIECrNAMEANoiOCATioN -. . ·-· ... --·--·-
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Describe Work: \ e 1J-e ~ \ '4 j tl I a~ JJ 4 ,,JJ ..
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Assessor's Parcel Number: _..:J. ........ 3 ..... 3_3 ... 3_.....5"~'/,...0 .... t7.....,Q.......,..s;/o~---------
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ALL UTIUTIES MUST BE LOCATED PRIOR TO ANY GRADING
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Auttmrl'Y. This applcation for 1 BuKdlng Permit must be signed by the owner of the property, d~ed abovet Of'
an 11uUlor1Zea agent. tf the slgnaWrt! below Is not that or the ChWner, ii separam letter of authanty. $1gned by the
OWner, must be provided with this Application.
I L!p! Aa;ess. A Bulh:ling Permit cannot be Issued without proof of lepl and adequate access to the property for
purposes of Inspections by the Building Olvis!ort. ·
Other P!rm!ts, Multiple separate permits may be required: (1t State Elec:trlal Permit, (2) Caunty OWTS Permit, I C3) another permit required for use on tile propeny identlfted above, e.g. State or County HIJhwilY/ Road Access or
I a State Wastewater Discharge Permit. I
Vold P9nnlt. A Bulkllng Permit bemmes null and void If lhe work authorized 15 not '°mmenced Within 180 days of ;
the date of Issuance and If work Is sus~ed or abandoned for a period of 180 days after commencement. '
aRTIFICA110N . -
' J hereby certify that l have read lhls AppUcatlon and that the lnfannatl on contained above Is true and carrea. I
) und.ntand ~t tho Qulldfng OJulclon ~ccoptc the AppllcatJan. :dona wtth tha plans and spedncatJons and other l data submitted by me or on my behalf {submlttals}, based upon mv certl&iltfon as to accuracy. Assuming
· completenen of tfle submlttals and app1oval of this Appllcatfon. a Bulldlng Perm It wlH be Issued granting
I l pennlsslan to me, as Owner_ to construct lhe strudure(s) and fadHties detaled on the submlttals reviewed by the
'I 8ulldlng Dlvlskin. In constderatlon of the Issi.ranee of the Building Permit, I agree lhat I and mv agents wlll complv
with pravlsians of any federa~ state ar local law resulatlns the work and the Garfield County Building Cade, OWTS
regulatTans and appllcable land use resuJatians (caunr.y RegulatlonCsn. I acknowledge that the Bulldlng Permit
may be suspended or rewked, upon nOllce from ttae County. Ir the locatfon, construction or use of lhe structure(s)
and radlty(les), described above, are not ~n c:ampUance with COUnty Reguladon(s) or anv other applicable law.
I hen!!!by gnnt permlsslon to the Buildl"I Division to eriter the property, described above, to Inspect the work. J
[ further acknowledge that the Issuance of lhe Building Permit does n Dt prevent the Building Offlclal &om: (1)
, requlrlns the correction of errors in the sulJmlttafs, If any, discovered after Issuance; or 12] stopping construction
I or use of the structure{s) °' facHlty(les) If such Is In violation of County Regulatlon[sJ or any other applfcable law.
j Review of this Af>pllciltlOI\ lndudlng sulamlttals. and lnspectlons of the work by the Butldlng Division do not
j constitute an acceptance of responsfbllty or liabJHly by the County of errol'5, omissions or disaepanctes. As the
1 Owner, I adcnawfedse that responsfbllity for compliance with federal, stare and local raws and Counry Regular.Ions
j rest with me and mv authorized agents. Inducing without limitation my archltect deslsner, enBinffr and/ or j
! pul1der_. ---------··-·--· _ -··-···----__ ··-·-·------· _________ J
I hereby ;icknowfedse that I have read and understand the Notice and Certification above as well as
have provided the required Information whfch Is c:arrect anti accurate ta the best of my knowledee.
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Property Owner Print and Sip Date
Ofl!ICIAL USE ONLY
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JOB NAME
CUSTOMER
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1100 N . 300 W ., P.O . Box 280
Spanish Fork, UT 84660
(801) 798-8676 • (800) 444-7361 -Toll Free
(801) 798-3605 -Fax
CONTACT
ORDER#
DATE ________ _
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