HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(97Ole4s-82t2
www. ga rfi eld-countv.com
TYPE OF GRADING
tr MAJOR MINOR
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INVOLVED PARTIES
Property Owner:
Mailing Address:
EmailAddress:
Phone:
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Contractor:
Mailing Address:
EmailAddress:
Mailing Address:
EmailAddress:
Phone:Architect:
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Phone: t/fu IEngineer:
Mailing Address
EmailAddress:
PROJECT NAME AND TOCATION
Job Addre5s:
5 ra.uare feet):
>({ ,}71 0 Octo J: '
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Lot
Earthwork Earthwork (Cubic Yards):
_Block
Describe Work:
Project Na
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Assessoy's Parcel Number:
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ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
NOTICE
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 regr-rlating the work and the Garfield CountrT Building Code, O\4/TS regulations and applicable lanC 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 usepf the structure(s) and facility(ies), described above, are not
in compliance with County Regulation(s) or any other applicable law.
I herebygrant 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
Appiication, inciuciing 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 inforrnation which is and accurate to the best of my knowledge.
Property Owner Print and Sign Date
Authoritv. ThisapplicationforaBuildingPermitmustbesignedbytheOwneroftheproperty,describedabove,or
anauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterof authority,signedbythe
Owner, must be provided with this Application.
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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 andvoidiftheworkauthorizedisnotcommencedwithinl8Odaysof
the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
OFFICIAL USE ONtY
Special Conditions Gtrr*Orwt- K {.,tgo'{xr gr>tz, $srugtwC- RIR;^ITQ^ ...Ygrv\J .- /^ (D.-\rra- r \ 1-t-i'r.\r- 't:-1- v\-s-\r\). brST-As.Jb O'-J€:l=b m-tfiq-q1rp5r- rr<Ke
Peilllit Fec:\oo do Mlsc Fees:'"[55 . coo Fees Paidtoo co
Balance due:a-<-)
Grading Permit:
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lszue Date:Zoning
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Approval Date