HomeMy WebLinkAboutApplicationGøffield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(e701 e4s-8212
www.garfield-countv.com
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INVOTVED PARTIES
Property Owner
Mailing Address:
EmailAddress:
Phone:
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Mailing Address:
EmailAddress:
Phone: ( IArchitect:
Mailing Address:
EmailAddress:
Phone:Engineer:
Mailing Address:
EmailAddress:
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Project Na
Descibe Work:
Job Address:
Assessor's Parcel Number:
Sub.Lot "_.--.-: Block
Earthwork (square feet):Earthwork (Cubic yards): A.M
AtL UTITITIES MUST BE TOCATED 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 ofthe property, described above, or
of the Owner, a separate letter of authority, signed by the
Owner, must be provided with this 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 required: (1) State Electrical Permit, (2) County OWIS 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. ABuildingPerm¡tbecomesnull andvoidiftheworkauthorizedisnotcommencedwithinlS0daysof
the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
CERTIFICATION
I hereby certify that I have read this Appl ication and that the information contained above is true and correct. 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 ãccurãcy. 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 Build¡ng 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 thâr 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 Perm¡t 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
const¡tute an acceptance of responsibility or liability by the County of errors, omissions or discrepancies. As the
I acknowledge that responsibility for compliance with federal, state and local laws and County Regulations
h me and my authorized agents, including without lim¡tat¡on my architect designer, engineer and/ or
I hereby acknowledge that I have reãd end understand the Notice and Certification above as well as
have provided the required information which is corregt ccurate to the best of my knowledge..t I//,)3
DateProperty Owner Priót and Sign
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100 09Permit
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Misc Fees:Tötâl Fe€s:
*loo,o9 Fees Paid:f lao. go
Balance due:áô_Gradlng Permit:
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Zoning:
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Signed Date