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Communlty Development Department
108 8rh Street, Suite 40f
Glenwood Springs, CO 81601
19701945"8212
www.sa rf¡eld-rountv.com
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GRADING PERMIT
APPLICATION
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Email Address:
Property Owner:
Maillng Address;Lr¡
Phone:
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ØMalling Address;
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Architect:
Malllng Address:
Email Address:
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Englneer:
Mailing Address:
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Assessor's Parcel Number:"ry4511qA80t6[ot
Describe Work:
Project Na
Earthwork (Cublc Yards):Earthwork {square feet}:
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ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
Authorltv. Thls appllcatlon for a Bulldlng Permlt must be slgned by the Owner of the property,
an authorized agent, lf the slgnature below ls not that of thê Ownêr, a separâte letter of authority, slgned by the
Owner, must be provlded wlth thls Applicatlon,
Lesal Access. A Bulldlng Permlt cannot be lssued wlthout proof of legal ãnd adequate access to the property for
purposes of ¡nspectlons by the Bullding Dlvlslon.
Other Permlts. Multlple separate permits may be requlred: (1) State Electrical Permít, (2) County OWTS Permit,
(3) another permlt requlred for use on the property ldentlfled above, e.g, State or County Highway/ noad Access or
a State Wastewater Discharge Perm¡t.
Vold permlt. A Bulldins Permlt becomes null and void íf the work authorized ls not commenced wlthln 180 days of
the date of lssuance and lf work ls suspended or abandoned for a period of 180 days after commencement.
above, or
understend that the Bulldtng Dlvlslon accepts the Appllcatlon, along wlth the plans and speclfications and other
data submitted by me or on my behalf (submlttals), based upon my certlfication as to accuracy. Assuming
completeness of the submlttals and approval of thls Appllcatlon, a Bulldlng Permlt wlll be lssued grantlng
permisslon to me, as Owner, to construct the structure(s) and facilltles detalled on the submlttals revlewed by the
Buildlng Divlsion. ln conslderatlon of the lssuance of the Bulldlng Permlt, I agree that I and my agents wlll comply
wlth provisions of anyfederal, state or local law regulatlng the work and the Garfleld County Bullding Codg OWTS
regulatlons and appllcable land use regulatlons (County ßegulatlon(s)). I acknowledge that the Buildlng Permlt
may be suspended or revoked, upon notice from the County, lf the locatlon, constructlon or use of the structure(s)
and faclllty(les), descrlbed above, are not ln compllance wlth County Regulatlon(s) or any other appllcable law'
I hereby grant permlsslon to the Bulldlng Dlvlslon to entêr the property, descrlbed above, to inspect the work' I
further acknowledge that the lssuance of the Bulldlng Permlt does not prevent the Buildíng Officlal froml (1)
regulrlng the correctlon of errors ln the submlttals, ff any, dlscovered after lssuance; or (2) stopplng constructlon
or use of the structure(s) or facillty(les) lf such ls ln vlolatlon of County Regulatlon(s) or any other appllcable law.
Revlew of thls Appllcatlon, lncluding subrnittals, and inspectlons of the work by the Bulldlng Dlvlslon do not
constltute an acceptance of responslblllty or llablllty by the County of errors, omlssions or dlscrepancles. As the
Owner, I acknowledge that responsibility for compllance with federal, state and local laws and County Regulatlons
rest wlth me and my authorized agents, lncluding without limitatlon my architect designer, englneer and/ or
read thls Appllcatlon and that the contalned above ls true and correct. II hereby
bullder,
which is
and Slgn
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Fees Pald:* loo.ooMlsc tee¡:Total Fees;* I oo.¡'Permlt tee:J ¡oo.ô'
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acknowledge
have provided the
Property Owner
understand the Notlce and Certiflcatlon above as well as
and accurate to the best of my knowledge.
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