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Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970194s-82t2
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Garfield County
INVOLVED PARTIES
Property irì1 'R-uo,.^r.Phone: f41o lVSU"qSl ë, t,
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Mailing Address:€,ô
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Contractor:fJ r*t Phone:
Mailing Address:
EmailAddress:
Architect:Phone: Élgj q ßq - 3 k'3 -l
Mailing Address:Ê.
EmailAddress:
Engineer:Phone :(11ô tqb4^ 3Ð93
Mailing Address:
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PROJECT NAME AND TOCATION
Project Name:
Describe Work:
Job Address:
Earthwork (square feet):
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Earthwork (Cubic Yards):
Assessor's Parcel Number:2f1Z
Sub.Lot _BIock
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ALL UT¡LITIES MUST BE LOCATED PRIOR TO ANY GRADING
i ÑiñriÑ. irrir ipóil."t¡on iòi á suilOinÈ perm¡t 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.
Legal Access. A Building Permit cannot be issued without proof of legal and adequate access to the property for
I purposes of inspections by the Building Division.
Other permits. Multiple separate permits may be required: (1) State Eleclrical Permit, (2) County OWTS Permit,
(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.
r CERTIFICATION
I heréby certify that I háve read this Application
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that ttre information contained above is true and'Cott"èt. 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, 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'
r I hereby grant permission to the Building Division to enter the propertç described above, to inspect the work. I
i further acknowledge that the issuance of the Building Permit does not prevent the Building Official from: (1)
i 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 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 me and my authorized agents, including without limitation my architect designer, engineer and/ or
builder.Ì
I hereby acknowledge that I have read and understand the Notice and Cert¡ficat¡on above as well as
have provided the requ¡red information which is accurate to the best of my knowledge.
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DatePropefi Owner Pr¡nt and Sign
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Special Conditions:
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Fees Paid:{ too,(,0f lo0,ôo
Total Fees:Misc Fees:Permit Fee:
+000,oo
Zoning:
Ru RA L6-/7-22
Issue Date:Grading Permit:
GR*P-1627
Balance due:+l
Signed Approval
BUttDtNG / PLANNING DIVISION :
Date
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