HomeMy WebLinkAboutApplicationD-Ll
,IRfi{.' .'1 Er-'v'- Community Development Department
108 8'h street, Suite 401
hl$V * tl ?[1Zt1 Glenwood springs' co 81501
l970l94s-82L2
www.garfi eld-countv.com
Garfield County
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INVOLVED PARTIES
Property Owner:
Mailing Address:
EmailAddress:
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Phone: 2Zc, I 30? OETY
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Emair Address:'T-<fWC*t:frA Q, tsn*Zu. (*r,
Phone: (iO1 )n? /?%
Mailing Address
Contractor:
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Phone: ( '363 | 6e8 1io t7
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Architect:
Mailing Address
Email Address:
Phone: ( )Engineer:
Mailing Address
EmailAddress:
PROJECT NAME AND LOCATION
Rturt N'z^.: Rz*.r.ot*tcs + ?**^Wr-- guapDescribe Work:
Job Address:
Project Name:
Assessor'sParcelNumber: 3177 ' OIJ' 66 -
Block
Earthwork (Cubic Yards) :"77 oo
7
Lot
Earthwork (square feet):
Sub.
ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
NOTICE
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 L80 days after commencement.
CERTIFICATION
I herebycertifythat I have read thisApplication and thatthe information contained above istrue 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
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 (Countv Regulation(s)). All Countv 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.
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 uise 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 understand the Notice and Certification above as well as
the required information which is correct and accurate to the best of my knowledge.
Property DateSign
OFFICIAL US aY @
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ff'ffi.".'Mise Fees:r orar tees:4ta oo '#zdi\."o
Balance due:
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Grading Permit:
GPAD-90r,3
lssue Date:
T{lro las+
Zoning:
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I-?e -z+BUILDING / PLANNING DIVISION
Signed
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DateI