HomeMy WebLinkAboutApplicationGarfield County
GRADING PERMIT
APPLICATIONCommunity Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(e7ol94s-82t2
www.Farfield-countv.com
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TYPE OF GRADING
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INVOTVED PARTIES
Property Owner:5-r:n Phone: tllO 1
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Mailing Address:Zqzu il-*.lersln el. C*"*l lril.hrln ('-O 9l +)\
EmailAddress:
Contractor:R A Cr.,.'irr,i'lrr>n Phone: ('l1o ) kfo -2O2,q
Mailing Address
EmailAddress:hl..l*. ush rJ r1r' ; Ih. cv"r . Lorn\
Phone: (1lo ) qK4 -9210
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Architect:
Mailing Address 9l ori ( ),4". Al,-,
EmailAddress:Kl. r cacc,h. fi:) 1"e.un,rr. r,r(i-, n€t
Engineer:L; n Ao,*er {\u nn I^{-Phone:
Mailing Address
EmailAddress:
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PROJECT NAME AND TOCATION
Project N
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Describe Work:f\nr
Job Address:t
Assessoy's Parcel Number 2\qqiq ro2ii3i
Sub.rot G'VB Btock Flq.)-
Earthwork (square feet), \,Arst>Earthwork (Cubic Yards):lUc
ALL UTITITIES MUST BE LOCATED PRIOR TO ANY GRADING
I hereby acknowledge that I have read and understand the Notice and Certiflcation above as well as
have provided the required information which is correct and accurate to the best of my knowledge.
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Property Owner Print and Sign Date
Permit must be signed by the Owner of the property, described above, or
an authorized agent. lf the 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 Euilding Permit cannot be issued without proof of legal and adequate access to the property for
purposes of inspections by the Building Divlslon,
Other Permlts. Multiple separate permits may be required: {1) Siate Electrical Permit, (2} County OWTS permlt,
(3) another permlt requlred for use on the property ldentifled above, e.g, State or County Highway/ Road Access or
a State Wastewater Dlscharge Permit.
Vold Petmit. A Building Permit becomes null and void if the work authorlzed is not commenced within 180 days of
the date of issuance and if work ls suspended or abandoned for a period of 180 days after commencement.
AuthoJtv. This application for a Bullding
I hereby certify that I have read this Application and that the information contained above is true and correct. I
understand that the Building Dlvision accepts the Applicatlon, along with the plans and speclfications and other data
submltted by me or on my behalf (submittalsl, based upon my certification as to accuracy. Assuming completeness of
the submittals and approval of this Application, a Buildlng Permit wlll be issued granting permission to me, as Owner, to
construct the structure(s) and facilities detalled on the submittals reviewed by the Building Division, ln consideration of
the issuance of the Bulldlng Permlt, 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 permil except for residential uses, are subject
to Artlcle 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 locatlon, construction or use of the structure(s) and facility(ies), desoibed
above, are not in compliance with County Regulation(s) or any other applicable law.
I hereby grant permission to the Building Divislon to enter the property, descrlbed above, to lnspect the work. I further
acknowledge that the issuance of the Euilding Perrnit does not prevent the Buildlng Offlcial from: (1) requiring the
correctlon of errors ln the submittals, lf any, discovered after issuance; or {2) stopplng construction or use of the
structure(s) or facility(ies) if such ls in violation of County Regulation(s) or any other appllcable law. Revlew of this
Application, including submittals, and inspections of the work by the Building Divlsion 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 deslgner, engineer and/ or builder.
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Permlt Feet --rAr\rYl .w Misc Fees:Total Feesrlcn OC "i'ffi oc
Balance due:Gradlns Permit:
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lss!le Datel Zonlns:Q{N
1-tz*BUtTDlNG / PL,ANNTNG D|V|STON I
Slgned Ap Date