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RECEIVEÐmmunity Development Department
108 8th Street, Suite 401
AUG 2 0 201ü Glenwood springs, co 8160r
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Garfield County
GRADINS PERMIT
APPLICATION
TYPE OF GRADING
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INVOTVED PARTIES
Property Owner:
Mailing Address:
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Mailing Address:
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Mailing Address
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Engineer:Phone: (_)
Mailing Address:
EmailAddress:
PROJECT NAME AND LOCATION
Project Na
Describe Work:I g,
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Job Address:2ÐT q CLr l"z
Assessol's Parcel Number:?^5 qL i 3o oo
Sub.Lot Block
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ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
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Authoritv. T his application for a Building Permit must be signed by the Owner of the property, described above, or
separate letter of authority, signed by thean authorized agent. lf the signature below is notthat of the Owner, a
Owner, must be provided with th¡s 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 requíred: (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 1.80 days after commencement.
] CERTIFICATION
I hereby certify that I have read this Application and
understand that the Building Division accepts the Ap
that the information contained above is true and correct. I
plication, 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 Divisìon. 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) stopping construction
or use of the structure(s) or facility(ies) if such is in violation of county Regulation(s) or any other applicabie law.
Review of this Application, including submittals, and inspections of the work by the Building Dívision do not
constitute an acceptance of responsibility or liability by the county of errors, omissions or discrepancies. As the
owner, I acknowledge that respons¡bility 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
builder
I hereby acknowledge that I have read and u nderstand the Notice and Certification above as well as
have req uired information which is correct and accurate to the best of my knowledge.
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and Sign Date
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OFFICIAL USE ONtY
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Fees Paid"sMisc FeesPermit Fee:
Zoning:lssue Date:
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Grading Permit:Balance due:
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BUILDING / PLANNING DIVISION
DateSigned Approvaf