HomeMy WebLinkAboutApplicationGørfield County
GRADING PERMIT
APPLICATIONCTI\IE
AUG 1 0 2017
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Development Department
8th street, suite 401
Springs, CO 81601
lL97O)945-82t2
TYPE OF GRAÐING
E] MAJOR M MrNoR
INVOLVED PARTIES
Phone: (qU )þlb'KÐ3(
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Property Owner:
Mailing Address
EmailAddress:
EmailAddress:
Phone:
Mailing Address
Contractor:
,tQ70 rJV t,b78àArchitect:
Mailing Address:
EmailAddress:
Engineer: Phone: (-)-
Mailing Address:
EmailAddress:
PROJECT NAME Af{Ð TOCAT¡ON
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Job Address:
ILotã
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ouAssessor's Parcel Number: 2L\l5?-0?t
Earthwork (Cubic Yards):
_Block
Describe Work:
Project Name:
Earthwork (square feet) :
Sub.
ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
NOTICE
I hereby acknowledge that I have read and understand the Notice and Ce rtification above as well as
have ded the required information which is correct and accurate to the best of my knowledge.
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Print and Sign DateP
Authoritv. ThisapplicationforaBuildingPermitmustbesignedbytheOwneroftheproperty,describeda
anauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterof authority,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 andvoidiftheworkauthorizedisnotcommencedwithinlB0daysof
the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
bove, or
CERTIFTCATION
I herebv certify that I have read this Application and that the information containe
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 constructthe structure(s) and facilities detailed on the submittals reviewed bythe
Building Division. ln consideration of the issuance of the Building Permit, lagree that land 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 crrors in thc 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 responsibil¡ty for compliance with federal, state and local laws and County Regulations
rest with me and my authorized agents, including wlthout limitation my architect designer, engineer and/ or
builder.
d above is true and correct. I
OFFICIAL USE ONIY
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Grading Permit:
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BUILDTNG / PLANNING DIVISION
Date
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