HomeMy WebLinkAboutApplicationc::G Garfield County
O>mmunity Development Department
108 81h Sreet, S.Jite401
Glenwood ~rings. CD 81601
(970) 945-8212
www .garfield-county .com
TYFE OF GRAiDING
O MAOR
INVOLV8) PARTIES
'MINCR
R-opertyO.Vner: .... \~t\2€'< lJ "S~o Rlone: ( 170 > {pJf) ... l&i~w
MailingAddress: 5~9 ~u.NT~ ~ ]OCf, 0-\"R:~~Aff.., Co 0Cto23
O>ntractor: l.£viAc.~ B0i.t...s.') of' fu~·v.T:~ Fhone:( CJzo) ?o'/-19"50
MailingAddress: 5~81 LolXU"~'< \<~ 0
1 O'/ C "4~"&9M\ktE, C.o S lfoZ 3 ,
Architect : ,U/ vl-Fhone: (.__ _ __,), ____ _
l
Mailing Address: 42 \c Cv¥ti: ~ I '5¥c GY>~c:Cocts ~.c·c.s F(p .
8igneer: X..\A..R'tl.. q. A~SoL.. Alone: ( 4zo ) Cf <IS .... b "30 5
MailingAddress: 501-z. C<>o.""i'f ~D \St/, £;.tfi.Ji.;::col\ Spr<.1~.s .. Co
ffi1ECr NAM EAND LOCATION
R-oject Name:_-5=-®~o _ __.._ ........... ......,__,=....._-==--------------
c:::le&:ribe Work: ~-c; ~ L 5--~ ~ C. 'l'-91 1 rO f ~ '-·,_JG
'J:~}l.-,(1 \101e} ~-\'t-~ -s; e. ~ C.P &UN ?°tWlJi.\L l...~1'"1e.!<:_
Asses&Jr's Parcel Number: _ _._R ....... -0"'-0-.......'.$_7,_,~ ...... · =z. ____________ _
SJb. ~LA~ \J,LJSe',J lot A: Block ____ _
Earthwork (&:fuare feet): IS, coo earthwork (OJbic Yards): ____.QO~----
All. UTILITIES M usr BELOC'A T8J ffi!ORTO ANY GRADING
NOTICE
Authoritv . This application for a B..lilding A:rmit must be sgnecl by the 0.vner of the property, des:ribed above, or
an authorized agent. If the sgiature below is not that of the ONner, a separate letter of authority, 9gned by the
ONner, must be provided with this Application.
L.eqa! Acress. A S...ilding Permit cannot be isa.ied without proof of legal and adequate acx:essto the property for
purposes of in~ions by the B..lilding llvison.
Q her Permits. Multiple separate permits may be required : (1) Sate Bectric:al Fermit, (2) OJunty ONTSA:rmit,
(3) another permit required for U!:eon the property identified above, e.g. Sate or Cbunty H~way/ RJad ~or
a Sate Wasewater lls::harge A:rmit.
Void Permit. A 0.rilding Permit beoomes null and void if the work authorized is not oommenoed within 180 days of
the date of isa.iance and if work is SU!'pended or abandoned for a period of 180 days after commencement.
CffiTIACA 11 O'J --
I hereby certify that I have read this Application and that the information contained above is true and correct. I
understand that the S...ilding llvi9on a:cepts the Application, along with the plans and !'pedfications and other
data 9.Jbmitted by me or on my behalf (SJbmittals}, based upon my oortification as to accuracy. Assuming
completeness of the 9.Jbmittalsand approval of this Application, a Building Fermit will be isa.ied granting
permis:ion to me, as ONner, to oonstruct the strudure(s) and facilities detailed on the rubmittals reviewed by the
B.Jilding llvison. In consderation of the iSSJance of the B..lilding Permit, I agree that I and my agents will oomply
with provisions of any federal, state or local law regulating the work and the <?erfield Cbunty S...ilding Cbde, ONTS
regulations and applicable land u!:e regulations(Cbunty ~lation(s)). I acknowledge that the B.Jilding Fermit
may be 9.J!'pended or revoked, upon notice from the Cbunty, if the location, construction or use of the strudure(s)
and facility(ies), des:ribed above, are not in compliance with Cbunty R:lg.llation(s) or any other applicable law.
I hereby grant permis:ion to the B.Jilding llvision to enter the property, des:ribed above, to in!'ped the work. I
further ad<nowledge that the isa.iance of the S...ilding Permit does not prevent the &lilding Clfidal from: (1)
requiring the correction of errors in the SJbmittals, if any, diSX>vered after iSSJanc:e; or (2) stopping construction
or use of the strudure(s) or facility(ies) if ruc:h is in violation of Cbunty Feg.Jlation(s) or any other applicable law.
R:Mew of this Application, induding SJbmittals, and inspections of the work by the E\Jilding llvi9on do not
constitute an acc:eptance of re!'ponsbility or liability by the Cbunty of errors, omiS'Sionsor dis::repandes. /ls the
ONner, I acknowledge that re!'p0n9bility for compliance with federal, state and local la.vs and Cbunty Rlg..Jlations
rest with me and my authorized agents, induding without limitation my architect de9gner, engineer and/ or
builder.
I hereby acknowledge that I have read and understand the Notire and certification above as well as
have provided the required information whidl is correct and acx::urate to the best of my knowledge.
Jei<£B;e';' Lo. 5"1i'P Q-kf zh.r/11,,
A-operty ONner A'int and Sgn ~ Oat~ I
OFROAL US: (X\JLY
&:>ecial Cbnditions: 1> r AfJu1fl)L
IM c, "77fJ./r/ ih TCH.
-ro ~rl
Misc Fees: Fees Paid:
\OO.Ob too.Do
Balance due: Zon in g:
IZ.