HomeMy WebLinkAboutApplicationCoGøffieId u nty
Comm unlty Devetopment Department
tOg grh Street, Sulte ¿óf
Glenwood Springs, CO g1601
(970) 9¡rs-8212
www.ga rf ¡eld-cou ntv.com
Project Name:
Describe Work:ç
0
TYPE OF G RADI NGtrMAJOR MINOR
INVOLVED PARTIES
Phone:
EmailAddress:
Property owner:
Mailing Address:
Phone:
I
ì
Contractor:
Mailing Address:
EmailAddress:
Architect: Phone:
Mailing Address:
EmailAddress:
Engineer:ìPhone:I
MaÍling Address
Email Address:
PROJECT NAME AND TOCATION
Job Address:q
Assessol's Parcel Number:-l L \or
Sub.Sr e-r \l i¡stcr BlockLot
Earthwork (square feet) :5, OOÒ gqç+ Earrhwork (cubic Yards):
GRADING
I hereby acknowledge that I have read and underctand the Not¡ce and Certification above as weil as
the required information which is correct and accurate to the best of my knowledge'
D LëU She ¿*s
AtL UTILITI
Print and Sign
ES IVIUST BE TOCATED PR¡OR TO ANY
ü5ì..1
Date
,t)
Date
other Permits' Multiple separate permits
Y1.:o."ired: {u state Etectr¡cal permit, (2)county owrs permit,
ltlåi:li,::i#i:ßü;:iJ]!ffiï: the propertv ¡oent¡neà-åiàu",
".e.
stare or county Hiehway/ Road Access or
vold permit' A Buirding permit becomes nu[ and void if the work authorized isthe date of issuance and if work is suspended or abandoned for a'feriod of 1g0
tsTh forapplication aAuthorltv.Buildi Permitng must be signed thebyânuthorizedthtfe Owneragent.theof orsignaturedescribedabove,tsbelow property,not that of the Ownerustmbe separateOwnerwith ofletter theprovidedthisuthority,bysignedApplication,
BuildinA Permit ncaLeral Access,gè not be issued without ofproof andlegal eccess theto forofadequatetheBupropertypurposesinspectionsbyildingDivision
not commenced within 180 days of
days after commencement.
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, t 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 propefi, described above, to inspect the work. I
further acknowtedge that the issuance of the Building Permit does not prevent the Building ofñcialfrom: (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 faciliw{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 acknowtedge that responsibitity for complíance with federal, state and local laws and county Regulations
rest w¡th me and my authorized agents, including without timitation my architect designer' engineer and/ or
builder.
I ce that have thisreadherebyrtify andApplication thethat containedinformation tsabove andtrue Icorfect,
dn thethat DivisionunderstaBuilding theaccepts Application,thewith andalong s otherandplansspecification
onsubmitteddatameor tfbehabymy (su based nbmittals)rt¡fice ascation toupomy accuracy.Assuming
theof lssubmitta na adcomleteness of lsthpprovalp Permit bewill issuedApplication,Building granting
D+Ðt¡LÇ m 0^r NtL's B 's'<
lr,kruvf
,n.?m*',r
C
B
Speclal C.ondltions:
b,q at ß9
PtTÞa Lí-Pn
ã.oFeesPaid:
*loo,Mlsc Fees:Total Fees:
ffoo,æ
Zoning;
P UrLA€rading Permit:
Gz*Þ -1asLl Lo Ll
lssuê Drte:@nl
Permit Fee:
.sf00.É
.f
Balancs due;
BUTLDTNG / P|ÂNNING DIVISION :
Slgned