HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfletd-countv.com
TYPE OF GRADING
L_❑ MAJOR
IN=11i1
GRADING PERMIT
APPLICATION
1
Ivi MINOR
r INVOLVED PARTIES n j
Property Owner: is c1& 140,4—
Mailing
ihMMailing Address: �� I e �.• Pr_
Email Address:
Phone:(
Contractor: ta14i Loci W /44:4 Matti— Phone: ( 9'70 ) Z74{ -MA
Mailing Address: /OZ Deer tlall AJ 6,4 £O $1& (7
Email Address: Wr +d3( 1o7Thud. CaM
Architect: Phone: ( )
Mailing Address:
Email Address:
Engineer: Phone: (
Mailing Address:
Email Address:
PROJECT NAME AND LOCATION
Project Name:
Describe Work:
1,01)4- eek "54 Poi ,ce-
Aitw 4441,ce, t ,[irLY,[war
1 V r-1 C1['��r1JGr
Job Address: 111 Pitt e7! vtti v •bv
Assessor's Parcel Number:
Sub. vesNuiivi V LLQ FiL 4 Lot 11 Block
Earthwork (square feet): /2/0=1 Lt)
Earthwork (Cubic Yards): Cb
� t:17
�-4
ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
NOTICE
I Authority. This application for a Building Permit must be signed by the Ow ler 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 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 Elect; ical Permit, (2) County OWTS Permit,
(3) another permit required for use on the property identified above, e.g. `tate or County Highway/ Road Access or
a State Wastewater Discharge Permit.
Void Permit. A Building Permit becomes null and void if the work authoriz :d is not commenced within 180 days of
the date of issuance and if work is suspended or abandoned for a period or 180 days after commencement.
CERTIFICATION
I hereby certify that I have read this Application and that the information c )retained above is true and correct. I
understand that the Building Division accepts the Application, along with 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. In consideration of the issuance of the Building Permit, I Igree that I and my agents will comply
with provisions of any federal, state or local law regulating the work and ti e Garfield County Building Code, OWTS
regulations and applicable land use regulations (County Regulation(s)). 1 a,:knowledge that the Building Permit
may be suspended or revoked, upon notice from the County, if the locatio 1, construction or use of the structure(s)
and facility(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, d,::scribed above, to inspect the work. I
further acknowledge that the issuance of the Building Permit does not pre rent 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) orfacility(ies) if such is in violation of County Repulation(s) or any other applicable law.
Review of this Application, including submittals, and inspections of the wo-k 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 prolrided the requiredrinf rmatian which is correct and accu -ate to the best of my knowledge.
1/zzit
Property Owner Print and Sign Date
OFFICIAL USE ONLY
Special Conditions: c'.lit.pN4. cr
px.g►u-r? R,tulgm)
Permit Fee:
ii
Balance due: ,
Misc Fees:
Grading mit.
&42-Per
BUILDING / PLANNING DIVISION
gRWis P3L/ 'I, ZLircPuiy
gned App
Total Fees:
issue Date:
Fees Paid:
100 ED, it( -1* ,2_) ►�
l�
Zoning:
i2)
2- 9-2i7
Date