HomeMy WebLinkAboutApplicationGurfield County
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Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
l970l94s-8212
www.garfield-countv.com
TYPE OF GRADING
tr MAJOR MINOR
GRADING PERMIT
APPLICATION
INVOLVED PARTIES
Property Owner:
Mailing Address:
Phone:o 6q
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EmailAddress:ol*,o'l E
Contractor: O,vr\ uf Phone: I )
Mailing Address:
EmailAddress:
Phone:Architect:(I
Mailing Address
EmailAddress:
Engineer:
Mailing Address:
EmailAddress:
PROJECT NAME AND TOCATION
Project Name:ür¿. .r.(.R.
Describe Work:
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Job Address:
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Assessoy's Parcel Number:zt-?q (ç3 qkq
Sub.Lot _Block
Earthwork (square feet),16,&Earthwork (Cubic Yards) :14)
ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
NOTICE
Authoritv. This application for a Building Permit must be signed by the Owner of the property, descri bed above, or
anauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedbythe
Owner, must be provided with this Application.
Lesal Access. ABuildingPermitcannotbeissuedwithoutproofof legal andadequateaccesstothepropertyfor
purposes of inspections by the Building Division.
Other Permits. Multiple separate permits may be required: (1) State Electrical Permit, (2) County OWTS Permit,
(3) another permit required for use on the property identified above, e.8. State or County Highway/ Road Access or
a State Wastewater Discharge Permit.
Voidpermit. ABuildingPermitbecomesnull andvoidiftheworkauthorizedisnotcommencedwithinl80daysof
the date of issuance and if work is suspended or abandoned for a period of 180 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 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, 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.
lherebygrant permission tothe Building Division to enterthe property, described above, to inspectthework. 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 Rpplication, including submittals, and inspections of the work by the Building Division do not
const¡tute 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 Notice and Cert¡f¡cation above as well as
have provi red information which is correct and accurate to the best of my knowledge
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Print and Sign Date
OFFICIAL USE ONLY ?^þ. t ¡ 66.ao o'l (to (z-ozz -$ræc.¿
Soecial Conditions:
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Total Fees
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Permit Fee:
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lssue Date:Zon¡ng:
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Grading Perm¡t:
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Balance due:rtl
BUILDING / PTANNING DIVISION
Signed Approval Date
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