HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 8th street, Suite 401
RECElVEnnwood springs, co 81501
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INVOLVED PARTIES
Property Owner:
Mailing Address:
Phone:1?o
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EmailAddress:
Contractor:Phone: (V1 ) 33 z- Gl 1 a
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EmailAddress:Cet,tr.
Architect: Phone:()
Mailing Address
EmailAddress:
Engineer:Phone: (_)
Mailing Address
EmailAddress:
PROJECT NAME AND TOCATION
Project Name tz
Describe Work:a
Job Address:r1 fzl, tz
Assessol's Parcel Number:2 rA fZP, z z+
Sub.Lot Block
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Earthwork (square feet):Earthwork (Cubic Yards) :
ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
NOTICE
Authoritv. This application for a Building Permit must be
an authorized agent. lf the signature below is not that of
4l,\
rty Owner Print and Sign
signed by the Owner ofthe property, described above, or
the Owner, a separate letter of authority, signed by the
Date
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'
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.
CERTIFICATION
I hereby certify that I have read th is 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 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 land use
regulations jcounty 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 sLtspended 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 ofthe
structure(s) or facility(ies) if such is in violation of County Regulation(s) or any other a'pplicable law. Review of this
Application, including submittals, and inspections of the work by the Building Division do not constitute an acceptance
oiresponsibilityorliabilitybytheCountyof errors,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 understa nd the Notice and Certification above as well as
ded the required information which is correct and accurate to the best of my knowledge.
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OFFICIAL USE ONLY
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Zoning:lssue Date:Grading Permit:Balance due:
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DateSigned