HomeMy WebLinkAboutApplicationGaffiireld County
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Community Development Department
MAY 2 0 202q 108 Bth street, suite 401
GAtTFtLLD ggiuQl,gnwood Springs, CO 8160L
C0 M ;.1 tJ I'tlTY ilEV[: L. JP;i i: f : (970) 945-8212
www.garfield-counW.con
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TNVOLVT'D PARTIE
Property Owner:dussc *.\oeh{r Phone: (qlD )&{8 - &S6o
Mailing Address: ''l *t't (1 vlAa L el \
EmailAddress: 5 ch o^n44.t
conffactor:Sel €Phone:
Mailing Address
EmailAddress:
Architect:oee.^-$*1X De*i pnone: {Jl{ | 43q- 3935
Mailing Address:
EmailAddress:
Qrot (PL kownn a
J"a"i C*n4an e de 0 br'1
Engineer:3 fi,*ak s E intcr(Phone:T,Ll73 - 553j
Mailing Address: ulSo ffiArnr 5+.(o 6tAlA
EmailAddress:
NAME.AFIB.MCA {OId .
Project Name Sc\e{.\\er ?e* .
Describe Work:i .14 o"", e"caA+,rr 5,$e tAd,i
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Job Address:63a\ ca iff Lar\naot{".1e .Co 8}eAZ
Assessor's Parcel Number:
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Lot tV l*.Block ru
Earthwork (square feet):5 000.s*a Earthwork (Cubic Yards):CI?e
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ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
NOTICE
Authoritv. This application for a Building Permit must be signed bythe Owner of the property, described above, or
anauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedbythe
Owner, musf be provided with this Application.
l-egal 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.
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.
CERrlFICATION
I hereby certify that I have read this Application and thatthe 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 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 by the 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 /and 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, if the location, construction 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 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 or use of the
structure(s) or facility(ies) if such is in violation of County Regulation(s) or any other applicable 1aw. Review of this
Application, including submittals, and inspections of the work by the Building Division do not constitute 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 authorized
agents, including without limitation my architect designer, engineer and/ or builder'
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
have prov uired info rmation which is correct and accurate to the best of my knowledge
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Prop e Owner Print and Sign Date
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'i36'.oo Fees Paid OO\oo.cFrPermit Fee:\nrA
Misc Fees:
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Balarice-due:Grading Permit:
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r4.L4BUILDING / PLANNING DIVISION
DateSigned