HomeMy WebLinkAboutApplicationGarfield County
GRADING PERMIT
APPLICATION
MINOR
OF GRADING
MAJOR
Communlty Development Department
lOB 8th Street, Sulte 401
Glenwood SPrlngs, CO 81601
(e701 e4s-8212
www.garf¡eld'countv.com
Project Na
Describe Work:
Job Address:
Assessol's Parcel Number:lLbq n-llÕa-63
Sub.!ot C-
-Block
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Earthwork (Cublc Yardsf: t
Phone:
Email
Property owner:
Mailing Address:
Email Address:
Phone:t Å.o-Ôt o:t'tPr B, tìContracton
Mailing Address:
Phone: 37hhlfl'Fb1Architect:
MaílingAddress:
EmailAddress:
J
Phone: $nt65-qlb1Engineer:
MailingAddress
EmailAddress:
nl (L ,q I f^lIhì ll
Earthwork (sguare feetf :
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Owner, must be provlded with this Appllcatlon.
te¡al Access. A òutlding Permlt cannot be lssued wlthout proof of legal and adequate access to the property for
purposes of lnspectlons by the Buildlng Dlvlslon.
Other permlts. Multiple separâte permlts may be requlred: (11 State Electrical Permit, f 2) County OWTS Pefmit,
t¡l -¿notf,er permit requlred for use on the property ldentified above, e.g. State of County Highway/ Road Accees or
a Stâte Wasteweter Discher8e Permit.
Vold permlt. A Building Permit becomes null and void lf the work authorlzed ls not commenced within 180 days of
the dete of lssuance and if work is suspended or abandoned for a period of 180 days after commencement.
Owner,
the described ofbemustedtheofabove,OwnerforPermltslgnby property,BulldlnglhisappllcatlonAuthorltv.
theofthattherateoffetterlgbelownotsepabyauthor¡ty,slgnedrftheauthor¡¡edan slgnatureå8ent.
I hereby certifo that I häve read this Application and that the information
understand that the Building Division accepts the Appl¡cåtlon, along with
data submitted by me or on my behalf (submittalsl, based upon my certificatlon 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¡Ç I agree that I and my agents will comply
with provisions of any federal, state or local law regulating the work and the Garf¡eld County Euilding Code, OWTS
regulat¡ons and applicable land use regulations (County Regulation(s)). I acknowledge that the Building Permit
may be suspended or revoked, upon notice from the Count¡ if the location, construct¡on or use of the structure(s)
and facility(ies), described above, 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 ¡nspect 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 ¡ssuance; or (2) stopping construct¡on
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 Appl¡cation, including submittals, and inspections of the work by the Building Division do not
const¡tute 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 author¡zed agents, including without limitation my architect designer, engineer and/ or
contained above ¡s true and correct. I
the plans and specifications and other
builder.
ALL UTILITIES MUST BE TOCATED PRIOR TO ANY GRADING
I hereby acknowledge that I have read and understand the Notlce and Cert¡f¡cat¡on above as well as
have provided the requlred information whlch is correct and accurate to the best of my knowledge.
J^-fu*-7124123
Property Owner Pr¡nt and Slgn Date
specrarcondltlont'
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Pald¡ooooooMlsc Fees:
lrlss-P¡ls:"R6radlng Permlt:Ealance due:
-7-?443
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