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Home My WebLink AboutApplicationGurfield County 4-@ REC E$gEErunity Development Department t08 8u Street, Suite tt01 MAY 0 I ?0H"n*ood SPrings, co 81501 g#^Tllpl[,fJl.,Yr.H#l$"''1.'.'ff li."* TYPE OF GRADING tr MAJOR INVOTVED PARTIES Property owner: ker.rt.. \\\sAX^ ls\"o *.^Phone:0 A Soe MINOR GRADING PERMIT APPTICATION Mailing Address: EmailAddress: Contractor:5I ^.rr*l,.r, \\.rne-< lJ-a Phone:4 s9 , Mailing Address: EmailAddress: : Architect:Phone: { Mailing Address: EmailAddress: i I Engineer: vl /,,a\o^6abie ^r.oyn Phone:11-)O ) jr{ tp\3.r Mailing Address EmailAddress: PROJECT NAME AND IOCATION Project Describe Work: Job Address: 'Qo (a 3 Assessol's Sub.Lot lQ Block Earthwork (square feet), Coc Earthwork (Cubic Yardsf :e< ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING i nonce 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 Divlsion. 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. 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), 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, lagree that land my agents wlll 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)). lacknowledge 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. 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 responsibility or liability by the County of errors, omissions or discrepancies. As the Owner, I acknowledge that 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 understa n the an ification above as well as have provided the required information which is a to the 2 Property Owner Print and Sign Date s ooOFFICIAL USE ONTY :A?r-Trt(6o'rr.>petFY ci^rp ?r>E Bcrc.Dt*c=- Pepp$rc- ?EvGd, $tfa-Doar*ra€€ yJff-lcs effi p€1C'{+BoeFt",fta? cm- DrSf ,,,.rp $[ta1:1 ar--Cc]rt?o L 9g6^, er$ ?ef-l,,,r Special Conditions:6rt trurcG- ffif;8 *Misc Fees:Total Fees:frrn.6'{r'ii\.* Zoning R lssue Date:Balance due $6.'e Grading Permit: G"nb-8qJ3 BUILDING / PLANNING DIVISION DateApp /6-t5 -21