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TYPE OF GRADING
MA.JOR i f MrNoR
¡NVOIVED PARNES
Property Owner:
Mailing Address:
Phone:
Emall Address:
Contractor:a-\€Phone:
Mailing Address:
r Emall Address:
Architect:N/*Phone;
Mailing Address:
Email Address::
Engineer:Phone:
Malllng Address:
Email Address: . ,
, þnol EgT NAMEAND TOCATION
Project
Describe Work:
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lobAddress: TlÞD. Od,n -Dr. 5i l+, CÔ 8t652
Asses¡ol's Parcel Number:
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Earthwork (rquare feet):(r(fr Earthwork tCublc Yards|:
Att UTIIITIES MUST BE LOCATED PRIOR TO ANV GRADING
NOTICE
Authority. This applicatinn for a Buildin6 Permit must be signed by the Owner eif the properll, detu'ttcd abçve, *t
¡n authori¿ed agent. lf the signature below is not that of lhe Õwner, a 5eparate lelter al åulh.rrtty' stgr:.etl b7 th*
Owner, must be provided with this Application.
legal Acçq$. A Building Permit cannot be issued w¡thoul proof of legal and adequate ãceeet te the praperty for
purposes of inspections bV the Building Division'
Other perrtratt. Multiple separate permits may be reguired: (11 State Ilectricat Perrnil, {2} Counly ÕWI5 Ferrnit'
(3) another permit required for use on the property idenlilied above, e.g. State or eounty Highwayl ñaad Âccess o¡
a State W¿stewater 0ischarge Permit.
Void permit. A Building permit becomes null and void if the work author¡¿ed i: not csmme*ced wilhin 188 day: of
the dãf e of issuance and if work is suspended or abandoned for a period of 18Û days ¿fte¡ <omma¡c€m€*t'
cERTlilcATloN
-..^ -^-r rr:- ¡^^r;--r¡^ ¿;:d çcrrecr. iI hereby certifv that I have read this Application and that the information contained above rs ttue
understand that the Building Division äccepts the Application, along with lhe planr and specrfìcatro*s ;nd *:he¡
data submitted by me or ûn my behalf {submittals}, based upon mY certification as to ðccuråcY. Asturî'ìrg
completeness of the submittals and approval of this Application, a Building Permit wrll be rssued grarting
permission to me, ðs Owner, to construct the structure{s} and facilities detailed on the ¡ubminat: re'*e:t'ed Þ? lhe
Building Division. ln consideration of the issuance of the Euilding Permtt, I agree that I and rny age*1s will co!!1glY
with provisions of any federal, state or locat law regulating the work and the Garfield CðuntT Burlding {ade, û'//T3
regulations and applicable l¿nd use regulations {County Regutation{s}}. I acknowledBe thåt the Êuildrng Perr¡ii
may be suspended or revoked, upon notice from the CountY, if the location, construction or i.¡se of lhe s:ru{Í}reit¡
and facility(ies), described above. are not in compliance with County Regulation{s) or any other appiicable iaw.
I hereby grant permission to the Building Þivision to entËr the property, decribed above. :o inspe<'t tt:3 ì¡t¡k. ;
further acknowledge that the issuance of the Building Permit does not prevent the Burlding üfficral fr*m: {1}
requiring the corf ect¡on of errors in the submittals. if any, discovered after issuance; or {l} stoppinE construct¡cn
or use of the structure{s} or facility{ies} if such is in violatior of County Regulation{s! or any other ¡pplc¡ble l¡w.
Review of this Application, including subm¡ttals, and inspections of lhe work by the Bu;lding Ðrvisicn do nrt
eonstitute an acceptance ol responsib¡l¡ty or liab¡lity by the county of errors, omissionl cr discrepa*=e5. ås t:ìe
Owner, I acknowledge that responsibility for compliance with federal, stale and local laws rnd Cou*þ 3egij¡at1on5
rest w¡th me and my authorized agents, including wlthout limitation my architect deligner, snglñeer andj or
bu¡lder.
I hereby acknowledge that I have read and understand the Not¡ce and Certif¡cstion above as wellas
have provided the requ¡red informatidt which is correct ðnd accurate to the best of rny knowledge
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