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Community Development Department
108 8th street, Suite 401
Glenwood SPrings, CO 81601
{970} 94s'8212
www.garfield-counW.com
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TYPE OF GRADING
MINORT] MAJOR
INVOTVED PARTIES
Phone:
Email Address:
Property owner:
Maillng Address:
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Contractor:
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Mailing Address:
Architect:
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Phone:
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Engineer:
Mailing Address:
Email Address:
LOCATIONANDNAMEPROJECT
Earthwork (square feet|:
Job Address:
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Lot _Block
Earthwork (Cubic Yards):
Assessol's Parcel Number:
Describe Work:
Project
Sub.
AtL UTILIT¡ES MUST BE LOCATED PRIOR TO ANY GRADING
Authoritv. This aPPlication
an authorized egent. lfthe
NOTICE
a State Wastewater Discharge Permit'
Void Permit. A Building Permit becomes
the date of issuance and if work is suspen
bove, or
by the
null and void if the work authorized is not commenced within 180 days of
ded or abandoned for a period of 180 days after commencement'
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 r"prr"a" p"rãit, may be required: (1) state Electrical Permit' (2) County owTS Permit'
(3) another perm¡t required for use on the property identified above, e'8' state or county Highway/ Road Access or
builder
I hereby acknowledge that I have reed and understand the Notice and Certification above as well as
have provided the required which is accurate to the best of my knowledge'
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Property Owner and S¡gn
OFFICIAL USE ONIY ?AI D.I'OO.o'c-Kf I oz zab
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Conditions:Special 6ra
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Fees Paid:
$ I OO.cLÞ
Total Fees:-f r oo,ÞMisc Fees:Permit Fee:
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Zoning:
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lssue Date:Grading Permit:
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Balance due:
$
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BUILDING / PTANNING DIVISION :
Signed ApProval
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Date