HomeMy WebLinkAboutApplicationGarfield County
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Community Development Department
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TYPE OF GRADING K vrrruontr MAJOR
INVOLVED PARTIES
Property Owner:
Mailing Address:
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EmailAddress:nÊ$ J LîR u[\]ÉFELO r , r'ür(
Contractor:S N YT€,Phone
Mailing Address:
EmailAddress:
Architect:sFrr€Phone ()
Mailing Address:
EmailAddress:
Engineer:RÊ rou*rsK( * f1 (LLAED Phone:(
Mailing Address:
EmailAddress:
PROJECT NAME AND LOCATION
Project LOT ßì I V ¿nÊv
Describe Work:Õ.CTITJA-?TqJ <rF RLrÐ&rIÇú
Job Address:7q tIES*rrPrAIJ tÜË)Y
Assessol's Parcel Number:
Sub.F\S{r€}J ËGoFr-Ptftu tr;ÞY Lot [*{f Block
Earthwork (square feet) :4,oQo Earthwork (Cubic Yards) :
ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
NOTICE
Authoritv. This application for a Building Permit must
an authorized agent. lf the signature below is not that
be signed by the Owner of the property, described above, or
of the Owner, a separate letter of authority, signed by the
Owner, must be provided with this Application.
Legal Access. ABuildingPermitcannotbeissuedwithoutproofof legal andadequateaccesstothepropertyfor
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 andvoidiftheworkauthorizedisnotcommencedwithinL30daysof
the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement'
CERTIF¡CATION
I hereby certify th at lhave read thisApplication andthatthe information contained above istrue a
understand that the Building Division accepts the Application, along with the plans and specificatio
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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 thisApplication, 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) 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
builder
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
have provided the required information which is co d accurate to the best of my knowledge.
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Property Owner Print and Sign Dete
OFFICIAL USE ONLY æ
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IConditions: .,t7Special
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'üiåïi',,Paid 6ôFees+Misc Fees:Permit Fee:îl on ô0
Zoning:
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lssue Date:/qÎ\l lrq
Grading Permit:
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Balance due:
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BUILDING / PLANNING DIVISION
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