HomeMy WebLinkAboutApplicationGørfield County
REGEIVE Development Depârtmêfi t
108 I'h Street, Suite 401
MAti I 7 ïfJTj¿ Ghnwoodeprings,cosl6ol
GARFTELD-ggl}ffi
COMMUÌ'¡ITY IIEVELOPME
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NVOIVED
Propertyûtrner:XTO Energy lnc Phone:P81 r9394132
MailingAddress:22777 Village Parkway
Êmail Address:mark.f.waren @exxonm obi l.co m
conuaao* Barg.?lh LLG ,.. ,, , phone:,303 7780527
MailingAddress:13781 Pacific Circle Mead, CO 80504
Ëmall Àddress:
ArdrÌtect; -,. ,,, - ,, Phone:
MaillngAddressi .*, , .
ÉmailAddress: ,,,,.-- ,., , . ,,,, .,, - - .
Engineer:Keith Gronwoller Phone:?8 1 979 - 5127
MallingAddress:NA
Emall Address¡keith.gronewol ler@williarns.com
PROIECT NAME ANO TOCAT¡ON
Proieet Gronewoller
Describe Work:See attached due to no being able to fit all the info. within this space'
Job Addre¡s;39¿780s6 -107.991206 I t31'1 H wyc .¿r lflî
Âssessot's Parcet Number:2173331A0007
5ub.Sec 34 6S 95W Iot
Ea ¡thwork (square teet):1657.8142 Farthwork (Cubic Yardsl:2500
ALt UTILITIËS MUST BE TOCATED PRIOR TO ANY GRAÞING
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Âuthoritv. Thïs application for a åullding Permlt must be signed by the Owner of the property, dessribed dbove, or
¿nauthorizedagent. lfthesignaturebelowisnotthatofthËOwner,ãsepân¡têletterofauthsrity,signedbythe
Ownef, must be provided with this Application.
lesal Acce¡s. A Building Permit cannot be issued ïu¡thout proof of legal and adeguate access to the pÍoperty for
purposes of lnspections by the Ëu¡ldhg Divlsþn,
9tüefp..e.r.pt¡. Multiple sepamte permits may be reguired: (11stâte Electr¡cäl Permit, (2) County OWTS Perm¡t,
l3) another permit required for use on the property identified above, e.g. State or County Highway/ ßoad Access or
a StãtÊ Welewater Dlsdrarge Perm¡t.
Void PermÍt. A BuildÍng Permit becomes null and void if the work authorized is not commenced w¡thin ¡80 days of
the date of issuence end if work is suspended or abandoned for a period of 180 days af¡er commencement.
I hereüy cert¡ry that I have read this Application and that the informatbrt conta¡ned above is true and çorrect. I
understand thetthe Suilding Division accepts the Applicatbn, alongwith the plans and specifications and other
data submitted by me or on my behalf (submittalsl, based upon my certification as to accrrreey, Assuming
completeness of the submittãls and approval of this Application, a Building Permit will be irsued granting
permísdon to me, as Owner, to construct the structure{s} Ðnd facil¡ties delailed cn the sr¡brniFals reviewed by the
Suildlng Dlvislon. ln consideration of the ¡ssuånc€ of the Building Perm¡t, f :gree that I and my ag€nts will comply
with pmvisions of any federal, state or local law regulatlng the wo¡k and the €¡rfield Cflnly Building Codq OWTS
regulatlons and appllcable land use regulations {County Regulatio¡{sll. I acknowledge that the Building Fermit
may be suspended or revoked, upon notice from the County, if the location, construction or use ofthe structure{s)
and facility{iesf, described above. are not ¡n compliance with County Regulation(s} or any other applíæble law.
I hercby grånt pem¡ss¡on to the Build¡ng ü¡vision to enter the property, described above, tt inspeft thê wôrlí ¡
further acknowledEe that the Ìssuance of the Buildng Permit does not pr€vent tfte Building Official from: (Ð
requir¡ng the correction of errors in the submitÌats, if any. discovered after issuancelor l2l stopp¡ng con$ruction
or use of the structure{s) or fäcifity{¡es} lf such ïs in violation of County Regulation(s} or any other applicable law,
Review of thls Application, lncluding submittals, and inspections of the work by the Building Divisbn do not
const¡tute an acceptãnce of responsibility or liabllity by the County of errors, omissions Er discrepancies- As the
Owner, I acknowledge that responsibility for sompliance with federal, state and local laws and Ëounty Regulatíons
rest with me and my authodzed ageûts, including without limitation my architect designer, engineer end/ or
builder-
I hereby acknowledge that I h¡ue read snd understand the Nol¡ce end Certificatíon above as well as
have prouíded the required information which is correct and accurate to the bestof my knowledga
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*oÉrtyhner Print ãnd Sign Date
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Sperial Conditionc
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Ealan¡c due:
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GÉdlnePemlt:
ËrÀp -7511
lss!¡e D¡te:
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Slgned Àpproval Date