HomeMy WebLinkAboutApplicationRECEIVED
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GARFIE.LD ÜÜUlt "¡
COMMUNITY D EVELOPMEITI
Community Development Department
108 8th Street, Suite ¡101
Glenwood SPrings, CO 81601
(9701945-82t2
www.ga rf¡eld-countv.com
TYPE OF GRADING
tr MAJOR
INVOLVED PARTIES
PropefiOwner:
Mailing Address:
OR
a Phone:
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EmailAddress:n
Contractor:
Mailing Address:
EmailAddress:
Architect:
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EmailAddress:
Engineer:
Mailing Address:
Mailing Address:
EmailAddress:
PROJECT NAME AND LOCATION
Project
Describe Work:
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Gørfield County
€RAI}ING PERMIT
APPTICATION
Job Address:TtA A t'Ê, 42t +z4(
Assessor's Parcel Number:9t11lLlÔ3oaf
Sub.Lot Block
Earthwork (square feet):70 00 Earthwork (Cubic Yards):
ALL UTIL¡TIES MUST BE TOCATED PRIOR TO ANY GRADING
NOTICE
Authoritv. This application for a Building Permit 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 author¡ty, signed by the
Owner, must be provided with this Application'
Lesal Access. A Building Permit cannot be issued without proofof legal and adequate access to the property for
purposes of inspections by the Building Division.
Other permits. Multiple separate permits may be required: (11 State Electrical 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
CERTIFICATION
I hereby certify ti"rat I håve read this Application andthat th; 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 certif¡cation as to accuracy, Assuming
completeness of the submittals and approval of this Application, a Building Permit will be issued grant¡ng
permission to me, as Owner, to construct the structure(s) and facilities detailed on the subm¡ttals reviewed by the
Building Division. ln consideration of the issuance of the Building Perm¡t, I agree that I and my agents will comply
with prov¡sions 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 äbove, 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
I 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 acceptãnce of responsibility or liability by the County of errors, omissions or discrepancies. As the
Owner, I acknowledge that responsib¡lity for compliance with federal, state and local laws and County Regulations
rest with me and my authorized agents, including without limitation my arch¡tect designer, engineer and/ or
lder
I hereby acknowledge that I have read and understand
have provided the required information wh¡ch is correct
$'a,l¡ ue I Øu',-.ÇJV
Property Owner Print and Sign
the Notice and Cert¡f¡cation above as well as
and accurate to the best of my knowledge.
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Date
OFFICIALUSEoNtY ?ND Stoo.ôo cl.
speciarconditions:
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Permit Fee
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M¡sr tees:lotal Feesr
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Fees Pald:t(OO.ao
Balance due:
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Gradlng Permit:
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Escc-9els:q.b 2Z Zon¡ng:
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DateSigned Approval
BUITDING / PLANNING DIVISION