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TYPE OF GRADING
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INVOLVED PARTIES
Property Owner:
Mailing Address:
EmailAddress:
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Contractor:CI1,^/ñøÊ Phone: ( )
Mailing Address:
EmailAddress:
Architect:Phone:
Mailing Address:
EmailAddress:
Engineer:Phone:
Mailing Address:
EmailAddress:
PROJECT NAME AND LOCATION
H I ¿^ [c"[î"Project Name
Describe Work:crV +þ C^J r i i<,^l¡( h'r^e
Job Address:
Assesso/s Parcel Number:
Sub.Lot tb Block
Earthwork feet):
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Earthwork (Cubic Yards) :ç l)ùD
ALL UT¡LITIES MUST BE LOCATED PRIOR TO ANY GRADING
NOTICE
Authority. This application for a Building Permit must be signed by t he Owner ofthe property, described above, or
anauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedbythe
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 Electrical 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.
Voidpermit. ABuildingPermitbecomesnull andvoidiftheworkauthorizedisnotcommencedwithinlS0daysof
the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
CERTIFICATION
I hereby acknowledge that I have read and understand the Not¡ce and Cert¡figltion 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
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I hereby certify that I have read this Application and that the 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. ln consideration of the issuance of the Building Permit, I agree that I and my agents will comply
with provisions 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, ifthe location, construction or use ofthe 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, described above, to inspect the work' I
further acknowledge that the issuance of the Building Permit does not prevent 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) or facility(ies) if such is in violation of County Regulation(s) or any other applicable law'
Review of this Application, including submittals, and inspections of the work 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
nformation contained above is true and correct. I
builder
OFFICIAL USE ONLY
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Special Conditions:
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Fees Paid:0u-rotalFeeslûù
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Misc Fees:PermitFee:
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Zon¡ng:,T+lssue Date:Grading Permit:
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Balance due:
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BUILDING / PLANNING DIVISION :
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