HomeMy WebLinkAboutApplicationGarfield County
GRADING PERMIT
APPLICATIONCommunlty Dorclopmrnt Dop.rtmcnt
10t 8th Strcct, $ultc ¿101
Glcnwood Sprlt¡r, CO t1601
(97019r5{r12
wnnr.rarff eld-counw.com
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E0 tvlllr¡ontr MAJOR
IilVOtVED PAiTICS
-0'2-4Propcrty Owncr:
Mellin¡ Addrcs¡:
tln.4¡.Phone:
Emall Address:0
Contr.ctor:¿[D\ru Phone: (47 o ;3 g -02'tY
Meiling Addrcs¡:o qL
Emrll Addrcss:
Architcct:Phone: ( )
Mellln3 Addrcss:
Em¡il Addrcss:
Enginecr: Phone:
C¿
Meiling Addre¡¡:
Emell Address:
PROJECÍ NAME AilD
Project
Descrlbe Work:t"k n
Job Addrcss:a"n Lo g[bíù
Asscssoy's Perccl Number:2\L12fi u{-oo 31 o
Sub.lot xr'l*_Block
Eerthwork (¡quare feetl:êvl oôô Earthwork (Cubic Yardsf: .
ALt UTILITIES MUST BE TOCATED PRIOR TO ANY GRADING
Perm it 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 separate letter of authority, signed by the
Owner, must be provided with this Application.
Les¡l 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 Electr¡cal Permit, (2) County OWTS Permit,
(¡) .*tt "t
permit reguired for use on the property identified above, e,8. State or County Highway/ Road Access or
a state wastewater Discharge Permit'
ized is not commenced within 1g0 days ofvoid Pcrmit. A Building Permit becomes null and void if the work authori
the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement'
cErilFlctrtoll
I hereby certify that I have read this Application and that the information contained above is true and correct. I
ons and other
data submitted by me or on my behalf (submittals), based upon my certification as to accuracy. Assuming
completeness of the subm¡ttals 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, 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 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 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 me and my authorized agents, including without limitation my architect designer, engineer and/ or
builder
I hereby acknowledge that I have read and understand the Not¡ce and Certification above as well as
have provided the requ¡red information which is correct and accurate to the best of my knowledge.
Property Owner Print and Sign Date
i
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understand that the Building Division accepts the Applicat¡on, along with the plans and specificati
OFFICIAL USE Ot{tY Pd. Jroo. *cx.*t17 tz/zt h¿zt
Special Condition¡:
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Fees Paid:
$ rôo.ôoTotal Fees:
S I ôo,ooMisc Fees:Pcrmit Fee:loô.o"
Zoning:
TsAat-
!$cs-ge!e:Grading Permit:
6 r¿AÞ -7 zt ?
Eelancc due:
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EUTLDTNG / PLANNING DIVISION
Signed Approval Dete
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