HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
ls7ol94s-8212
www.garfi eld-cou ntv.com
TYPE OF GRADING
tr MAJOR MINOR
INVOLVED PARTIES
Property Ow n"r, loh^ ano\ lvlnclisEq lJcr{."[t lJ Phone
Mailing Address:P'o ' (.,t 9g $sao\ fi'a^Ac rr 331) I
EmailAddress:1 11
Contracto r: Jon.kilo 6o^s'{tr.c lr.,n Phone: t170 I 3)1 - 3(sd
Mailing Address:73 4"rlrsk ^Dc C^.|,^nrlnk Ccs
EmailAddress:q
Architect:Phone: (_)
Mailing Address
EmailAddress:o\5
Engineer:R,w,J."'.. 5-ir u jurn I Phone: Qo< 1 74J aofJ
Mailing Address
EmailAddress:
PROJECT NAME AND TOCATION
Project Name /5 |c..r. slr"c Dr'[,d
Describe Work:Exzauc.bsx c 1^ nzr t L-ta
Job Address:/5 l'/o,<.s\.-e J2. Carb""4o k ca t/( )3
Assessol's Parcel Number:t//.o /t7
Sub.Lot t/tl _Block
Earthwork (square feet) :./a>qt Earthwork (Cubic Yards):
ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
NOTICE
Authoritv. ThisapplicationforaBuildingPermitmustbesignedbytheOwneroftheproperty,describedabove,or
anauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedbythe
Owner, must be provided with this Application.
Legal 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 separate permits may be required: (1) 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.
VoidPermit. ABuildingPermitbecomesnull andvoidiftheworkauthorizedisnotcommencedwithinl80daysof
the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
have the required information which is correct and accurate to the best of my knowledge.
? /ts /"t r/
Property Owner Print and Sign Date
CERTIFICATION
lherebycertifythatlhavereadthisApplicationandthattheinformationcontainedaboveistrueandcorrect. 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 certification as to accuracy. Assuming completeness of
the submittals and approval of this Application, a Building Permit will be issued granting permission to me, as Owner, to
construct the structure(s) and facilities detailed on the submittals reviewed bythe Building Division. ln consideration of
the issuance of the Building Permit. I agree that I and my agents will comply with provisions 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)). All County development requiring a permit, except for residential uses, are subject to Article 7 of
the Land Use and Development Code. I acknowledge that the Building Permit may be suspended or revoked, upon
notice from the County, ifthe location, construction or use ofthe 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 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, discover'ed after issuance; or (2) stopping construction or use of the
structure(s) orfacility(ies) if such.is in violation of County Regulation(s) oranyotherapplicable law..Review of this
Application, including submittals, and inspections of the work by the Building Division do not constitute an acceptance
of responsibilityorliabilitybytheCountyoferrors,omissions,ordiscrepancies. AstheOwner, lacknowledgethat
responsibility for compliance with federal, state and local laws and County Regulations rest with me and my authorized
agents, including without limitation my architect designer, engineer and/ or builder.
OFFICIAL USE ONtY
SDecial Conditions: -JPELrdr !srrqrrr"""'Gfr*o.xl cr 4qf Va/c- c*.J p (Zt:K., Sc,tuDr*-{i
Q-n r^ -- (,>- rcr..- rf'- i?Grtrr;r-i ?to.l Dr- T\r.<+.-^trr?cst. Dr:rtr
lg-YL^'v(-I YE-HIJ\Hu l-L v I - - 'tv L/vr I
IFQ-oStaP <?PTal(t--
D6r#i+ E66. a' i'Fre,oo
T^+^l E^^-. - 4\'"T'oO .Qt)
E^^-D-il. 'Yi1n,w
Balance due:
@
Grading Permit:
CrQ.L\e"A<
lssue Date:Zoning:
PLLD
4-Z(.'z+BUTLDTNG / PLANNTNG DtVtStON
Signed Date