HomeMy WebLinkAboutApplicationGørfield County
Commu nity Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(97Ole4s-82t2
www.garf ield-cou nW.com
TYPE OF GRADING
tr MAJOR MINOR
PROJECT NAME AND TOCATION
INVOLVED PARTIES
Property Owner:
Mailing Address:
EmailAddress:
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Contractor:fo l¿ÞéT€4*41"/â Phone: ( )
Mailing Address:
EmailAddress:
Architect:5eÇS ø¿S on/Phone: Úlo I "oZ
Mailing Address:TLZ Nlq,^t Çr.(*{\xt sr+ut Co ç\LLT
EmailAddress:5<<s o çol4.rE .N¿(
Engineer:EQ^l€ff ( ¡-,LL4-Q Phone:tqto t?63--3223
Mailing Address:3Zo t4q rJ Sr. Gago¡ ¡rkv€ Co ÈILLJ
Emaif Address= ØL N{€ KO tL4,( 4- øqq*.LD\
Project Name éoruS TQllLt ç\áT *tÉçÐ G4A+b.l
Describe Work:W/]c¡.1g.5 d4a.+bE
Job Address:ZSIJ- Co rlxl-rt RA, llL ¡,Jl*tø CÒ ?tr
Assessol's Parcel Number:z3oß tlz b3ot-7
Sub.Þ t ñv o'.¡1b+ r¿s Lot t-7 Block
Earthwork (square feet):I.()b(>Earthwork (Cubic Yards):
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ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
NOTICE
Authoritv. This application for a Building Permit must be signed by the
an authorized agent. lf the signature below ¡s not that of the Owner, a
Owner ofthe property, described above, or
separate letter of authority, signed by the
understand that the Building Division accepts the Application, along with the plans and specificatio
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'
Void permit. A Building permit becomes null and void if the work authorized is not commenced within 180 days of
the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
CERTIF¡CATION
I hereby certify that I have read this Application and that the information contained above is true a nd correct. I
ns 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, if the location, 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, 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) stopp¡ng 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 andl or
builder
I hereby acknowledge that I have read and
have provided the requ¡red information whi
' Sr/r"'*
understand the Notice and Certification above as well as
ch is correct and accurate to the best of my knowledge.
il6lrltk
Property Owner Print and Sign Date
I
OFF¡CIAL USE ONLY
Special Conditions:
Total Fees:
DD.M
Fees Paid:
DÐDo
Misc Fees:Permit Fee:
b0.00
lssue Date:Zon¡ng:kPerm¡t:GradBalance d
Signed
L- fl, .2a18
Date
BUITDING / PLANNING DIVISION :
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