HomeMy WebLinkAboutApplicationGarfield County
Com munity Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
le7ol94s-82t2
www.garfield-countv.com
TYPE OF GRADINGA vn:on iJ[ vrruon
INVOLVED PARTIES
7er.5EmailAddress:
Property Owner:
Mailing Address:
Phone:@te
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Phone:(r70;*-6J r5fro*Contractor:
Mailing Address
EmailAddress:
Phone: ()Architect
Mailing Address
EmailAddress:
EmailAddrer* A/----to o .r2/{7___ d
Phone:%
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PROJECT NAME AND LOCATION
Job Address:
^ +t-a 1rs,nt-A-
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Describe Work:
Project Na
Lot 7
Earthwork (Cubic Yards):
_Block
Earthwork (square
Sub.
fDruoxscutr Pernr*-
ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
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Authoritv.This application for a Building 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 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
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 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, if the location, construction or use of the structure(s) and facility(ies), described above,
are not 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
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 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 a nd Certification above as well as
have provided the required information which is and accurate to the best of my knowledge.
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Property Owner Print and Date
OFFICIAL USE ONLY
sPeciar conditions?€.{),Fr lT @DfLr v q:rrJ r+/ . ..f-uft r-tft 6 q Lt
fcur',or*rcrr C;O/6ICUE= -F fepfic- Fer.rU*f- Ra,rte.rJ
Fe @''ti'iih .ooMisc Fees:Permit Fee: '\nuoo
Zoning:
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Grading Permit:
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lssue Date:Balance due-o-
BUILDING / PLANNING DIVISION
Date
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