HomeMy WebLinkAboutApplicationGurfield County
Community Development Department
RECEIVED 108 gth Street, Suite 401
iUL" t s ?01$ u'""*i3loì'ri:ï'r::81601
GARFIELD COUIITY www.sarfield-countv.com
GOHIIUNIÍY DEVELOPI EIIÍ
TYPE OF GRADING ff vrruontr MAJOR
INVOTVED PARTIES
Phone: û1O t 4 D+ qtb I
lEmailAddress:
Property Owner:
Mailing Address:
SÑNø
Contractor:
AS þßoVe
æç Phone:
Mailing Address
EmailAddress:
Phone:Architect:
Malling Address
EmailAddress:
Phone:
z II
Gtlmr,uorJ Stnt
0
rnlEngineer:
Mailing Address:
EmailAddress:
PROJECT NAME AND LOCAT¡ON
fßbJob Address:
Parcel Number
t1
(
Lot
Project Name
ll/t
uare feet):Earthwork Earthwork (Cubic Yards):
Describe Work:
Sub._Block
ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
NOTICE
Authoritv. This application for a Building Permit must be signed by the Owner of the property, described above, or
anauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedbythe
Owner, must be provided with this Application.
Leeal 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.
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.
CERT¡FICATION
lherebycertifythatlhavereadthisApplicationandthattheinformationcontainedaboveistrueandcorrect. I
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 approvalof 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, ifthe location, construction or use ofthe structure(s)
and facility(ies), described above, are not in compliance with County Regulation(s) or any other applicable law.
I herebygrant permission tothe Building Division to enterthe property, described above, to inspectthe 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 Certificat¡on above as well as
have provided the requ¡red information which is correct and accurate to the best of my knowledge.
ln/û/(/3n;Ð +/q/n
P;;{";y o;d; wi.,{, *,ß,cl oat/ -{
ôôOFFICIAL USE ONLY
'l,ffiruu ' ''44 Q*t+g'5 ,/rsz /zop^E
{¿--'rr flZL) /aLL)
Special'Ð*tD"ov
Fees Paid: -^Þ/a).u)
Misc Fees:
\.\ìù
Total Fees:
-Þtnn. æPermit Fee: ^ -*tôn,u'
Gradí¡lgPermit:
c.?trl)-.6;X lssue Daìe:-+i\oln Zoning:
Pu-n$ô,oo
Balance due:
7-/0-BUITDING / PLANNING DIVISION
Date