HomeMy WebLinkAboutApplicationGar.field CountY
ComrnunitY DeveloPment Department
108 8th Street, Suite 401
Glenwood SPrings, CO 81601
{970} e4s-82x2
www.sarfield-countv.com
TYPE OF GRADING
. E MAJOR
' llvot-eo PARTIES
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, PropertY Owner:
, Mailing Address:6e s
I Emaill\ddress:
€ontractor:ilaa offiqb t \N\
Mailing Address
EmailAddress:
Architect:
Mailing Address
Phone;
t
Phone:
e?
EmailAddress:
Phone:
8f.try
:Engineer:
Mailing Address
EmailAddress:
PROJECT NAME AND LOCATIO N
Project Na
Describe Work
, Job Address:
Assessot's Parcel
Sub.Lot
fz.&-
-/
e_t Block
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 signed hy the Owner of the ploperty, described above, or
. anauthorizedagent. lf thesignaturebelowisnotthatoftheOwner,aseparateletterof authority,signedbythe
, Owner, must be provided with this Application.
Leeal A"..ss. 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 maV be required: (1) State [lectrical Perrnit, (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 uf issuance arrcl if work is suspended or abandoned for a pcriod of L80 days aftcr commencement.
CERTIFICATION
I hereby certify that I have read this 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), basecl upon my certification as to accuracy, Assuming completeness of
the subrnittals and approval of this Application, a Building Permit will be issued granting pertrtissiotr to n]e, ds Owtrer, to
construct the structure(s) and facilities detailed on the submittals reviewed by the Building Division. ln consideration of
,theissuanceof theBuildingPermit, lagreethatlandmyagentswill complywithprovisionsof anyfederal,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 Euilding Permit may be suspended or
revoked, upon notice from the County, if the location, construction or use of the structure{s) and facility(ies), described
: above, are pot 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
r 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 responsibility or liability by the County of errors, omissions, or discrepancies. As the Owner, I acknowledge that
responsibility for cornpliance with federal, state and local laws and County Reguiations rest with me and my authorized
agents, including without lirnitation my architect designer, engineer andl ar builder.
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
have provided the reguired information which is correct and accurate to the best of my knowledge.
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Property Owner Print and Sign Date
OFFICIAL USE ONLY
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Balance due:Grading Permit:
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