HomeMy WebLinkAboutApplication7È'¿,ts rrt
7=n
ä iÉË
,r ú-,r .-t>ü! Vzú l"l þ..3=
oü
Dwelopment Departnent
108 8tb $reet, Sulte¡101
Glenwood Sprirgs, CO 81601
(970194ff212
www.ga rf¡eld-cou nW.com
Garfield Counfit
TYPE I )FGRADING
MINOR
PARTIES
Proper
Mailin¡
Email/
Pftone:
Phone:
Address:
Address:
0wnen
f.ontra
Mallir{
Emall/
Archite
Mailin¡
Email I
Co gt5¿>¡-{
Phone:-?Ôct:âu
ddress:
Address: 3l% € €-Ã 6ra¡&
ITIAMEAI{D LTOCAnOil
l/\Phone:L
Address:Z1o'¡ ( PJ (1r*n ol Jrtcjn n 4o €lfo4
Emall
Prolect
.1'.
Work:
Job
Parccl ilumber:
_BlockLotSub.
{square fieetl:1Ca,o Eartlwork (Cubk Yardsl: _
I.
ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
This application for a Building Perm¡t must be signed by the Owner ofthe property, described above, or
ana agent. lf the signature below ís not that of the owner, a separate letter of a¡Jthority,sþned bythe
must be provided with this Appl¡cat¡on.
A Building Permit cannot be issued without proof of legal and adequate aæess to the propefi for
of inspections by the Building Ðivision.
Multiple separate permits may be reguired: (1) State Electr¡cal Permit, (21 County OWTS permit,
(3)permit required for use on the property identified above, e.g. State or County Hþhway/ Road Access or
a State Ðischarge Permit.
A Building Permit becomes null and void if the work authorized is not commenced within 180 days of
the of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
cert¡fy that I have read th¡s Àppjicai¡àn in¿ it "tttrãînøm"iur "ã"t"¡r,.¿ "¡;;;;it*;d ã*r""t. f-
that the Building Division accepts the Application, along with the plans and specifications and other
data by me or on my behalf (submittals), based upon my cert¡f¡cât¡on as to accuracy. Assuming
of the submittals and approval of this Applicatíon, a Building Perm¡t w¡ll be issued grant¡nt
permi to me, as Owner, to construct the structure(s) and facilities detailed on the submittals reviewed by the
Division. ln consideration of the issuance of the Building Permit, ¡ agree thãt I and my agents will comply
with of any federaL state or local law regulating the work and the Garfield County Building Code, OWTS
and applicable land use regulations {County Regulation(s}). I acknowledge that the Building permit
may be or revoked, upon notice from the County, if the location, construction or use of the structure{s)
and described above, are not in compl¡ance with County Regulation(s) or any other applicable law.
grant permission to the Building Division to enterthe property, described above, to ¡nspect the work. I
further that the issuance of the Building Permit does not prevent the Building official from: (1)
the correction of errors in the submittals, Íf any, discovered after issuance; or (2) stopping construction
the sÛucture{s} or facility{ies} if such is in violation of County Regulation(s} or any other applicable law.
Review th¡s App¡icat¡on, including submittals, and inspections of the work by the Building Division do not
en acceptance of responsibiliÇ or liability by the County of errors. omissions or discrepancies. As the
Owner,acknowledge that responsibility for compliance with federal, state and local laws and County Regulations
rest me and my authorized egents, including without limltation my architect designer, engineer andl or
builder
acknowledge that I have read and understand the f{otice and c€rt¡ficetion above as well as
have the required information which is correct and accurate to the best of my knowledge.
Print and Sign Date
or use
UsEoNtY p^tÞ _ # tÐCI.* c. C ro/osf zozz
Gradtn? a.*au,tnerâ
,,/ûri Fenæ/Ê
Special
3
ÉLÈe-ó1-Zz -Z&t grèk
bu rel/A*)
t"''nI"+l
o ô '6-
Misc Fees:'*fi'¿to,*Fees Pã¡d:
$loo,6a
Ealance
\Eø Gradlng Permft:
øF-AD^18{o
lssue l¡ater
to /l/ zo2-e-
Zonlng:
V . t.D,
/0,z,zL/ PtAJ{Ntlrt€ DlVtStOt{ :
SþnedApproval Date