HomeMy WebLinkAboutApplicationGarfield County
$tt:CHiV{:i}
Com munity Development Department
$[t' ?" q 2t]2{ 108 8th street' suite 401
Glenwood Springs, CO 81601
l-,],:.: :r', :r-i.i i-.'.,r",;;'i'i''r" (gl}lg4S-82L2
ilii:'r, ., i / iri:i::i rfrlririitlwww.garfield-countV.com
TYPE OF GRADING
tr MAJOR El'lvttruon
0r
Lct Phone:
dt
INVOTVED PARTIES
EmailAddress:
Property Owner:
Mailing Address:
Phone: (Contractor:
Mailing Address:
EmailAddress:
Phone: (Architect:
Mailing Address:
EmailAddress:
Phone: (_)Engineer:
Mailing Address:
EmailAddress:
PROJECT NAME AND LOCATION
dress:Job
Lot _Block
Earthwork (Cubic Yards):L\,@o
Assessor's Parcel Number
Earthwork (square feet) :
Sub.
Project Name:
Describe Wo
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. 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.
VoidPermit. ABuildingPermitbecomesnull andvoidiftheworkauthorizedisnotcommencedwithinl80daysof
the date of issuance and if work is suspended or abandoned for a period of 180 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
constructthe structure(s) and facilities detailed on the submittals reviewed bythe 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, 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.
lherebygrantpermissiontotheBuildingDivisiontoentertheproperty,describedabove,toinspectthework. lfurther
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 applicable law. Review of this
Application, including submittals, and inspections of the work by the Building Division do not constitute an acceptance
of responsibilityorliabilitybytheCountyof 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 understand the Notice and Certification above as well as
h provided the required information which is correct and accurate to the best of my knowledge.
-Z
'JLat ?a
Property Owner Print and Sign Date
OFFICIAL USE ONtY \
special conditions: a:frrlA.\b9(l-4_(Ja<t4- <tA 6*- 4, op 1-s,'9
Dr:f lsF b hr6lFS ^,t(tlC+\cf\5- prc<ztrtt?R$
zr.,A\rr.tGNU: t{^tTa,ers DpQhA€5-
Pi'fi5e'.oo Misc Fees Total Fees:loo cro '"['d5 .oo
Balance due Grading Permit:
2'A.Ab-R9t+
lssue Date:Zoning:
R.S
1'7a'2qBUILDING / PLANNING DIVISION
Date