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Garlield Countye
Commun¡ty Development DePartm€nt
108 gú Street, Suite ¿t{11
Glenwood Springs, CO 81601
(e701 e4s-8212
www,Ía rfield-cou nty.com
TYPE OF GRADING
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].f:E MAJOR MINCIR
INVOTVED PARNES
Property Owner:Phone:
Mailing Address:
Email Address:
Contractor;Phone:
Mailing Address:
Email Addressz
Architect;Phone:
MailingAddress:
Email Address:
Engineer;Phone:
Mailing Address;
f
Email Address:
PROIECT NAME AND LOCATION
Project
Describe Work:
Job Address:
Assessor's Parcel Number: 2181 3oZ ot oo I
Sub.Lot
-Block
-_
Earthwork lsquare feet)Earthwork lCubic Yardsl:)
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ALL UTITITIES MUST BE TOCATED PRIOR TO ANY GRADING
NOTICE
AuthorltY. This application for a Building Permit must be signed by the Owner ofthe property, described above, or
an authorized agent. lf the signature below is not that of the Owner, a separate letter of authority, signed by the
Owner, must be provided with this Application.
Lçlal Accç¡¡, A BuildÍng Permít cannot be íssued without proof of legal and adequate êccess to the property for
purposes of inspeclions by the Building Division'
Othgr Permlt¡, Multiple separate permits may be required: (1) State Electrical Permit, (2) County OWTS Permit,
{3} another permit required for use on lhe property identified above, e.g. State or County Highwayl Road Access or
a State Wastewater Discharge Perm¡t.
Vold Permlt. 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.
CERTIFrcANON
iÈereby certify that I have read this Application and that the information contained above is true and correct' I
understand that the Buildlng 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 approval of this Application, a Suilding Permit will be issued granting
permission to me, as Owner, to construct the structure(s) and facifities detailed on the submittals reviewed by the
Building Division. ln consideration of the igsuance of the Bu¡ld¡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 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 hereby grant permission to the Building Division to enter the propefi, described above, to inspect the work. I
further acknowledge that the issuance of tl¡e Building Permit does not prevent the Building Official f¡om: (1)
requiring the correctíon of errors in the submittals, if any, discovered after issuance; or (2) stopping construction
or use of the structure(s) or facllity{ies} if such is in violation of County Regulation(s} or any other applicable law.
Review of this Applieation, including submíttals, and inspections of the work by the Building Division do not
constitute an acceptance of responsibility or liability by the County of errors, omissíons 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 rny architect designer, engineer and/ or
builder.
r hdàùt airnòwie¿se thãt I have read and understând the Notice and Certification above as wellas
have reguired information which is correct and accurate to the best of my z
Owner Print and Date
OFFICIALUSEONTY PJ. $ tc5Øpo cc lt {ot /zo>l
Soecial Conditions:ÐPËcrallunqrrr""'' oruu repreØþ sbraSa æn*aryr ls
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Fees Paid:* too.9Total lee¡:f f oc¡.€Misc Fee¡:Permit Fee;
s lo0.€
Zoníng:
2.vrzAt-
Grading Perm¡t:
Gz*o-7231
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tt I oq /zozt
Balance due:+d
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BUII.DIJ{G / PLANNING DIVISION :
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Date