HomeMy WebLinkAboutApplicationGørfield County
RECEIVED Community Development Department
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TYPE OF GRADING
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INVOLVED PARTIES
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EmailAddress:
Property owner:
Mailing Address:
Phone:
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Contractor:
Mailing Address:
EmailAddress:
Phone:Architect:
EmailAddress:
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Mailing Address
Engineer:
Mailing Address
EmailAddress:
PROJECT NAME AND LOCATION
Earthwork (square feet): i.l,O ei O Earthwork (Cubic Yards): l{?Ô O
Job Address:t
Lot
Describe Work:
Project Name
Assesso/s Parcel Number:
Sub.Block
ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
NOTICE
Authoritv. This application for a Building Permit must be
an authorized agent. lfthe signature below is not that of
signed by the Owner of the property, described above, or
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 perm¡ts. Multiple separate permits may be required: (1) State Electrical Permit, (2) County OWTS Permit,
1a¡ unot¡"r 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
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 Applìcation, 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 perr¡ission to tlre Buildirrg Division to enter the property, dcscribed 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 w¡thout limitation my architect designer, engineer and/ or
builder
I hereby acknowledge that I have read and understand the Notice a nd Certification above as well as
have provided the required information which is correct and accurate to the best of my knowledge.
I hereby certify that
understand that the
Property Owner Print and Sign
I have read this Application and that the information
Building Division accepts the Application, along with
contained above is true and correct, I
the plans and specifications and other
I¿I
Date
rd
OFFICIAL USE ONLY
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Fees Paid:Total Fees:
D0--Misc Fees:Perm¡t Fee:
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Zoning:g-
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Grading Perm¡t:
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Balance due:
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BUILDING / PLANNING DIVISION :
DateSigned
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