HomeMy WebLinkAboutApplicationGaffield County
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RECEIVEIþmmunity Development Depa rtment
108 8th Street, Suite 401
$,lAY '¡ 6 201$ Glenwood springs, co 81601
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TYPE OF GRADING
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INVOLVED PARTIES
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Property Owner:
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Contractor:
Mailing Address
EmailAddress:
Phone: (_)Architect:
Mailing Address:
EmailAddress:
Phone: IEngineer:
Mailing Address
EmailAddress:
PROJECT NAME AND LOCATION
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Job Address:7 7
Assessol's Parcel Number:
Sub.,^ i6 t?,l Block
Ea rthwork (square feet) :), ooe Earthwork (Cubic Yards)100
ALL UTILITIES MUST BE TOCATED PRIOR TO ANY GRADING
NOTICE
Authoritv. This aPPlication for a Building Permit must be signed by the Owner of the prop erty, described above, or
uthority, signed by thean authorized agent. lf the signature below is not that of the Owner, a separate letter of a
Owner, must be provided with this Application.
Lepal 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.
Otlter 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 L80 days after commencement.
CERTIFICATION
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 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)). 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,to¡nspectthework. 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 constructlon
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 Regulat¡ons
rest with me and my authorized agents, including without limitation my architect designer, engineer and/ or
builder
I hereby acknowledge that I have read an d understand the Notice and Certification above as well as
have provi ded the required information which is correct and accurate to the best of my knowledge.
I hereby certify that I have read this Application a
understand that the Building Division accepts the
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roperty r Print and Sign
nd that the information contained above is true and correct' I
Application, along with the plans and specifications and other
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OFFICIAL USE ONtY
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Fees Paid
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Total Fees loo.ooMisc Fees:Perm¡t Fee
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Zoning:clusrHrrc
lssue Date:Grading Permit:
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Balance due:
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BUILDING / PLANNING DIVISION
Date
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