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Communlty Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 8L601
l970l94s-8212
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Property Owner:
Mailing Address:
EmailAddress:
Contractor:
Mailing Address:
Phone: (17O¡
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GRADING PERMIT
APPLICATION
WPE OF GRADING
MINORtr MAJOR
INVOTVED PARTIES
Mailing Address:
EmailAddress:
}\)F^/Ë Phone:tlArchitect:
Engineer: NC' t€ Phone¡
Mailing Address:
EmailAddress: ,
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PROJECT NAME AND LOCATION
Job Address:
feet|:bV)ü
LotSub.
Earthwork (Cubic Yards|:
_Block
Describe Work:
Project Na
Assessoy's Parcel
Earthwork
EmailAddress:
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ALt UTILITIES MUST BE TOCATED PRIOR TO ANY GRADING
NOTTCE
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
have provided the required information which is correct and accurate to the best of my knowledge.
L*E
Property Owner Print and Sign Date
Authoriw. This application for a Building Permit must be signed by the Owner
an authorized agent. lf the sígnature below is not that of the Owner, a separate letter of authority, signed by the
Owner, must be provided with this Application.
Lesal 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.
Other Permits. Multiple separate permits may be required: (1) State Electrical Permit, (2) County OWTS Permít,
(3) 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 commenced within 180 days of
the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
ofthe property, described above, or
CERTIFICATION
I hereby certify that I have read this Application and that the information conta
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 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 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 Building Permit
may be suspended or revoked, upon notice from the County, ¡fthe location, construct¡on or use ofthe structure{s}
and facility(ies), described above, are not ¡n 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 Building Official from: (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 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 Building Division do not
constitute an acceptance of responsibility or liabilíty 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 me and my authorized agents, including without limitation my architect designer, engineer and/ or
ined above is true and correct. I
builder
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See/**"HSpecial Conditions:
Paid:
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Total Fees:
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Fee:Permit$t M¡sc Fees:
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lssue Date:Zoning:
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Gradlng Perm¡t:
GRAÞ -7261
Balance due:+/
/lhhBUILDING / PLANNING DIVISION
Signed Approval Date
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PROPI RTY DESCRIPTION (MAY NOT BT, COMPLE TE)
217719100316
SECT,TWN,RNG:17-6-93 DESC: LOT 6 & SESW
SECT.TWN,RNG:18-6-93 DESCr A TR lN LOT
1? SECT,TWN,RNG:19-6-93 DESC: NENE SEC
T,TWN,RNG:20-6-93 DESC: N2NVU DESCI ËXCE