HomeMy WebLinkAboutApplicationGurfield County
Community Development Department
l0g 8th Street, Suite 401
Glenwood Sprlngs, CO 81501
leTole4s-82L2
www.garfi eld-cou ntv.com
WPE OF GRADING
E MINORtr MAJOR
4020 County Road 103, Carbondale, CO 81623
Phone:
EmailAddress:drummroll90@aol.com
p70 f45.02o7Christian Lewis
INVOTVED PARTIES
Property Owner:
Mailing Address:
Mailing Address:
EmailAddress:
contractor, N/A Phone: ( )
Mailing Address:
Email Address:
Architect:N/A Phone :{ I
Mailing Address:
EmailAddress:
Phone: ( )Engineer:N/A
PROJECT NAME AND TOCATION
4020 cR 103Project Nam
Describe Work:Creation of a p rivacy berm, and partial demolition of exisiting
privacy berm.
Job Address:4020 County Road 103, Carbondale, CO 81623
Assessor's Parcel Number:239118200152
Sub. [ot-Block
Earthwork (square feet):10125 Earthwork (Cubic Yards). 4,500
ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
Authoritv. This application for a Bu ilding Permit must be signed by the owner of the property, described above, or
an authorized agent. lfthe signature below is not that of the Owner, a separate letter of authority, signed by the
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,
i3) 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 L80 days of
the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
CERTIFICATION
I hereby certifo that I have read this Application and that the 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 be half (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 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, if the 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, 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 law' Review of this
Application, including submittals, and inspections of the work by the Building Division do not constitute an acceptance
oi iesponsibility 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
have provided the required
I have read and understand the Notice and Certification above as well as
is correct and accurate to the best of my knowledge.
c5 zl 2q\o/\l-o'S
Property Owner Print and Sign
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Date
OFFICIAL USE ON
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Fees Paid:ooTotal Fees:odMisc Fees:Fee:oo
lssue Date:Grading Permit:Balance due
5-L3-24
BUITDING / PTANNING DIVISION :
Date