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Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(9701945-8212
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INVOLVED PART¡ES
Phone:Property Owner:
Mailing Address
EmailAddress:
Phone:
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Contractor:
Mailing Address:
EmailAddress:
Phone:
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Mailing Address
EmailAddress:
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Mailing Address:
EmailAddress:
PROJECT ÀIAME AND LOCATION
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Job Address:
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Block
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Lot
Earthwork (Cubic Yards):
Assessor's Parcel Number:
Earthwork (square feet) :
Sub.
Describe Work:
Project Na
ALt UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
I hereby acknowledge that I have read and understand the Notice and Certi fication above as well as
is correct and accurate to the of my knhavetredon
Property Owner Print and Sign Date
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Authoritv. This application for a Building Permit must be signed by the Owner of the property,
anauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedbythe
Owner, must be provided with this Application.
Leeal 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 andvoidiftheworkauthorizedisnotcommencedwithinl80daysof
the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
described above, or
I hereby certify that I have read this Application and that the information contai
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, 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
turther acknowledge that the issuance of the Bulldlng Permit does rtt-tt prevetrt the Buildirrg 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
ned above is true and correct
builder
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Fees Páid:
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Perm¡t Fee
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Balance due
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Signed Date
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