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Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(e70) e4s-8212
www.garfield-counW.com
Gørfield County
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Architect:Phone:
Mailing Address:
EmailAddress:
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Property Owner:
Mailing Address:
Email Address:
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Engineer:
Mailing Address
EmailAddress:
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Job Address:
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Assesso/s Parcel Number: 24e7$3Oaæ I
Earthwork (square feet), ,\ Enc¡
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Earthwork (Cubic Yards):
Describe Work:
Project
Authoritv. This application for a Building Permit must be signed by the Owner of the property, described above, or
an authorized agent. lf the signature below is not that of the Owner, a separãte 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.
Othêr Perm¡ts. Mult¡ple separate permits may be required: {1} State Electrical PermiÇ 12) County OWTS Permit,
(3) another permít required for use on the property identified above, e.g. State or County Highway/ Road Access or
a State Wastewater Discharge Permit.
Vcid.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-
I hereby cert¡fy that I have read this Application and that the information conta¡ned 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 certlficat¡on as to accuracy. 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 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 Buitding 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 property, described above, to inspect the work. I
further acknowledge that the issuance of the Building Permit does not prevent the Bu¡lding Official from: {1)
requiring the correct¡on 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 Bu¡lding 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 nle and my authorized agents, including without limitation my architect designer, engineer and/ or
builder.
ALt UTILITIES MUST BE TOCATED PRIOR TO ANY GRADING
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
have provided the required information which is and accurate to the best of my knowledge.
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Property Owner Print and Sign
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Tot¡l Fees:t loo, oo Fees Paid:
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Permit Fee:
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Mi¡c Feec:r
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lssue Date:
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Zoning:Balance due:#-d Gradlng Perm¡t:
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BU|IDING / PIANNING DTVISION
Signed Approval Date