HomeMy WebLinkAboutApplicationGarfield CountyRECEI
JUH 1 2 A0l$orrunity Development Department
108 8th Street, Suite 401
GARt-iU.LD CfJUNT$l"nwood Springs, CO 81601
coMiirllr,lilyi)F\/ii! )PMENT (gZO) g4S_82L2
www.garfield-countv.com
OF GRADING
MAJOR R
INVOTVED PARTIES
Phone 57oProperty Owner:
Mailing Address:
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Contractor:
Mailing Address
Email Address:
Architect:b
Phone:
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Mailing Address
l Email Address:
Engineer:Phone:t
Mailing Address it"95 ll, l,*tlrM. ,ur6 40 Oeu,te-C*>0Zof
EmairAddress: 'Tt2r[A , gMtT]-" A (L?-*dr"r,n e8-S , C-$,4.
ECT NAME AND TOCATION,!8,9r
Project Name:54 sr fr*ng'*<- fn'a+
Describe Work:hAN
Job Address:
Assesso/s Parcel Number:
Sub
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-Brock
Earthwork (square feet) :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. ABuildingPermitcannotbeissuedwithoutproof of legalandadequateaccesstothepropertyfor
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 andvoidif theworkauthorizedisnotcommencedwithinl80daysof
the date of issuance and if work is suspended or abandoned for a period of L80 days after commencement.
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 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 regulatingthe 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, 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
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.
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
have provided the required i on which is correct and accurate to the best of my knowledge.
Lyn-flAt€ 7 uz.4
Property Owner Print and Sign Date
OFFICIAL USE ONtY
Special Conditions: ftapuJ l-tV €r'.lGrllersRlao C\P&J r^f,>S
7>, ry- <er4\tLl(-,@,u, /Z{sD F-{-1;v6 C+JSTF<^Jqt4\t-
CetfiIZae AJo(1ca>5 (J fraJ
Permit Fee: \L{nrCr 9u Misc Fees:C)QTotal Fees:
t-{r^r-l oor-\ooFees Paid:
lssue Date:Zoning:Balance due Grading Permit:
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BUILDING / PLANNING DIVISION I
DateApproval