HomeMy WebLinkAboutApplicationGarfield County1;'
[}tl'1" fi $cPffiffunity Development Department
i .. . ., . : , 1 , lQ8 8th Street, Suite 40l
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TYPE OF GRADING
tr MAJOR E[ wttruon
INVOTVED PARTIES
Property Owner:
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phone: (97t1 | 37q - fttJ?
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contractor: Bre.uce A*.Jnne,Phone:
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Mailing Address
EmailAddress:
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Mailing Address (
Engineer:
PROJECT NAME AND LOCATION
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Job Address:A \kns,-ffla f7)e<a t\pirtp fl,'{le
Describe Work:
Project Name:
Assessorrs Parcel Number: 2, X-q 2S t O / b / /
Earthwork (square feet) :
Su b.n'Oe LPeek Ea,{nls Lot //_Block
Earthwork (Cubic Yards) :
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.
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
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 regulating the work and the Gar-field County Building Code, OWTS regulations and applicable land use
regulations (County Regulation(s)). AllCounty 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
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structure(s) or facility(ies) if such is in violation of County Regulation(s) or any other applicable law. Review of this
Application, including submittais, anci 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 information which is correct and accurate to the best of my knowledge.
Beur" ,4Blrou"u < 4 ro /z /z*ar'Property Owner Print and Sign Date
OFFICIAL USE ONLY
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Balance dueA- \-,
Grading Permit:
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lssue Date:Zoning:
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Date
BUITDING / PLANNING DIVISION
Approval