HomeMy WebLinkAboutApplicationGarfield County
Com munity Development Department
108 8th StreeÇ Suite 401
Glenwood Springs, CO 81601
(e701 94s-8212
www.earfield-countv.com
TYPE OF GRADING
tr MAJOR ¡l MrNoR
owner: Jl"/¿. //rt*ot U¿
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Property Phone: Úþ I Ç/g 6q?4
Mailing Address
EmailAddress:
Phone: (q 70 | 623 OMconffactor:
Mailing Address:
EmailAddress:
Phone: (ï70 t
Mailing Address
Address:
4hÆù4 Phone:Engineer:
Mailing Address:
EmailAddress:
Job Address:
ldo)ù5þlM
LOCATION
5ILot_Block
Earthwork (Cubic Yards):
PROJËCT NAME
Describe
Project
Earthwork (square feet):
Assessot's Parcel
Sub.
AtL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
Authoritv. This application for a Building Permit must be signed by the Owner of the propertç described above, or
an authorized agent. lf the signafure below is not that of rhe Owner, å separâte le$er of authority, signed by the
Owner, must be provided with this Application.
legalAccess. ABuildingPermítcannotbeissuedwithoutproofof legal andadequateaccesstothepropertyfor
purposes of inspections by the Building Division.
Other Permíts. Multiple separate permits may be required: (1) State Electrical Permit, (2) County OWTS Permit,
(31 another permit required for use on the property identified above, e.g. State or County Highway/ Road Access or
a State Wastewater Discharge Permit.
Void Permit. A Building Permit becomes null and void if the work authorized is not csmmenced within 180 days of
the date of issuance and if work is suspended or abandoned for a period of L80 days after commencement.
CERTIFICATION
I hereby certify that I have read this Application and that the information contained above is true and correct. I
understand that the Building Division accepts the Application, along with the plans and specificatìons 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 Building Permit will be issued granting
permission to me, as Owner, to construct the structure(s) and facilitíes detailed on the submíttals reviewed by the
Building Division. ln consideration of the issuance of the Building PermÍt, I agree that I and my agents will comply
with provísions of any federal, state or local faw 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 notíce from the County, ífthe location, construction or use ofthe structure(s)
and facilíty(ies), described above, are not in compliance with County Regulation(s) or any other applicable law.
I hereby grant permission to the Building Ðivísion to enter the property, described above, to inspect the work. I
further acknowledge that the issuance of the Building Permit does not prevent the Buildìng Official from: (1)
requiring the correction of errors in the submittals, if any, discovered after issuance; or (2) stopp¡ng 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, ìncluding submìttals, 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 acknowledge that responsibìlity for compliance wlth federal, state and local laws and County Regulations
rest w¡th me and rny authorized agents, including without lirnltation my architect designer, engineer and/ or
builder,
I hereby acknowledge that I have read and understand the Notice and Certificat¡on above as well as
have provided the required information which is correct and accurate to the best of my knowledge.
Property Owner Pr¡nt and S¡gn fftnrc 0rq
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Permlt Fee:
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Misc Fees;Total Fees:
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Fee¡faid:
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Balance due:
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Gradlng Permlt:
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lssue Date;Zonlng:
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/2¿-z/BUITDtNG / P|-ANNING DIVISION
Signed Approval Date