HomeMy WebLinkAboutApplicationC-5
Community Development Department
RECEIVED 1oB 8,h Street, Suite 401
AUG 2 s 2ot8
u'""*i3loì'ü:ï'r::81601
GARFIELDCOUN@
COMMUNITY DEVELOPMENT
TVPE OF GRADING
tr MAJOR MINOR
Gøffield County
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i INVOLVED PARTIES
fal*r, c.o *¿Phone:IProperty Owner:
Mailing Address:
EmailAddress:
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Phone: û7Ù t374 -AZn
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Contractor:
Mailing Address:
EmailAddress:
EmailAddress:
Phone: Û7A I -Kb(>r
Mailing Address:
Architect:
Phone: ç+LO ¡ Zl/^ -åÊ1"f>Engineer:
Mailing Address:
EmailAddress:
PROJECT NAME AND TOCATION
Project Name
Describe Work:
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Job Address:aolç <ÐP-l Lt,L-s Þa-
üï*r,rrnss KS C-Õ Blbô I
Assessor's Parcel Number:1.mzô lÒ4 0¡)7-
Sub.L lot 2-_Block
Earthwork (square feet):Earthwork (Cu bic Yards) :
ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
NOTICI
Authoritv. This application for a Building Permit must
an authorized agent. lf the signature below is not that
be signed by the Owner ofthc property, described above, or
of the Owner, a separate letter of authority, signed by the
Owner, must be provided with this Application.
lesal 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 perm¡t 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.
CERTIIICATION
I hereby certify that I have read this Application and that the information contained above is true and correct. I
the plans and specifications and otherunderstand that the Building Division accepts the Application, along with
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, owrs
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, construct¡on 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 errors in the submittals, if any, discovered after issuance; or (2) stopping construction
o|. ,r" oith" 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
builder
I hereby acknowledge that I have read and u nderstand the Notice and Certificat¡on above as well as
have provided the required information which is correct and accurate to the best of my knowledge.
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Owner Print a nd Sign Date
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Special Conditions:
Fees Paid:
6toa,oo
Total Fees:
oo, oôMisc Fees: . .N/4Permit Fee:Sloo,Òo
P(^Þ
Zoning:lssue Date:Grading Permit:Balance due:
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BUILDING / PLANNING DIVISION
Signed Approval Date