HomeMy WebLinkAboutApplicationGørfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 94s-8212
www.sa rJi e ld-co u ntv.com
TYPE OF GRAD¡NG
E MAJOR K MrNoR
INVOLVED PARTIES
Property Owner:
Mailing Address:
EmailAddress:
Phone:
Contractor:Phone:
Mailing Address wl+
EmailAddress:
Architect:N-\-e-c \qst-^n Phone:
Mailing Address: qO S-. -3J.\t|.'
Ctr-,^. ¡*J Sorv.or (Õ Xnôlfd-EmailAddress:
Engineen Phone: I )
Mailing Address
EmailAddress:
PROJECT NAME AND LOCATION
Project Name JcVrn:on A, J.I¿+ì clf\
Describe Work:
Job Addresst ÒLt
Assessor's parcetNumber: â?gi ) 3qOO 3¿aÔ
sub. lscjr¡on â5 \e.rsns\sn ?mt È*r..,^ 8P *Ñ@ct
î.mo L o*s e.rtlr*o9i'oEarthwork (square feet):(Cubic Yards):
AtL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
NOTICE
Aqlhqr;¡y. This applicatio¡r for a Buildirrg Permit rnust be signecl by the Owner of the property, described above, or
arr ar.¡thorized agent. ìf the s¡gnâture below is nüt that of The Owner, a separate letter of uuthority, signed by the
Owner, must be provìded with this Application.
LJggql4çfÊss, ABuilclingPermitcônnotbeissLledwithoutproof of legal andadequateaccesst0thepropertyfor
purposes of inspections by tlre Building Division.
Other PetmiE. MLrltiple separate permits nray be requiredr (1) State Ëlectrical Permit, (2) County ÜVI/TS Permit,
{3} another permit required for use orr tlre propeüy identified atbove, e.g. State or County l'lighwayl Road Accers or
a State lvastewåter ûisclrarge Permit.
\¡od.-[gflIrit A Building Perniit becomes null ancl void if the wc¡rk authr:ri¿ecl is not contmenced within 180 days of
the date rrf issr-rance ancl if work is suspendecl or al¡andt¡necl far a perioti of 180 days after conrnlerìceme¡ìt.
CERTIFICATION
I hereby certify thal I have reaC this Application ancl tlrat the informatiorl contained al¡ove is true ancl correct, I
understand tlrat the Builcling Division accepts the Ap¡ilication, along with the ¡rlans and specifirations ancl other
data submittecl by me or on my belralf {submittals), based upon my certificãtion as tÕ accuracy. Assuming
conrpleteness of the submìttals and approval of this Application, a lluilding Permit will be issued granting
perrnission tû me, as C)wner, to construct the structure{s) ancJ facilities detailed cn the submittals reviewed by the
Building Division.ln ci:r'rsicjeration of the issu;lnceof the Building Permit, lagreÊ that lancl myagentswill comply
with ¡:rovisions ol any ferleral, state or local law regulating the work and the Gariield Çounty Building Code, OWTS
regulations arrd applicable land use regulations {Corrnty ftegulation(s}}. I acknowledge that the Building Pelmit
may be suspendecl or revokecl, upon notíce from the County, if the locatio¡r, construction rrr use of the structure(s)
and facility(ies), described above, âre not in compliance with County Regulation{s) or any other applicable law.
I hereby grant permissioir to tlre Building fJivision to enter the property, clescribed above, to inspect the work. I
lurtlrer acknowledge tþat the issuânce 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 conltruct¡on
or use of the structure(sl or facility{ies) if such is in violation of County Regulation(s) or any other applie¿ìble law.
Review of this Applicatio¡r, including submittals, arrd inspections of the work by the Builcling Division do not
constitute an ac€eptance of responsibility or liability by the Courrty of errors, omissions or discrepancies. As the
Owner, I acknowledge that responsibility for compliancÊ with federal, state and local laws and County Regulations
rest with me and my authorir.ecl a6ents, includirtg without limitation my architecl designer, engineer and/ or
buildcr.
I hereby arknowledge thät I have read and understând the Notice and Certification above as lvell ã3
have provided the requ ired infarmation which is correct and accurate to the best of my knowledge.
qJ
Property üwner Pr¡nt and S¡gn Þate
zt
-aOFFICIAI UsE ONLY
Special Cond¡tions:'6+öiö b þTY""g- a^rxl þSt <,4s Tt¡l$utc-Dtxs6-çèù,*1¡a
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Fee¡ Paid:Total Fees:oo oo
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Date