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!Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
l970l94s-82t2
www.Rarfieldcountvco.gov
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TYPE OF GRADING
tr MAJOR MINOR
Gurfteld County
INVOLVED PARTIES
Property Owner:
Mailing Address:
Phone: (9zo I bre ^Szo5
EmailAddress:
Contractor:* ^^.>-Phone: (-)
Mailing Address:
EmailAddress:
Architect:Phone: l4?a I
Mailing Address:2,44 <)htr ArK ln A.J r+t^^r)inn A.ar qt u
EmailAddress:
Engineer:Phone:112a I
Mailing Address
EmailAddress:
PROJECT NAME AND LOCATION
Project Name:
Date of Completion:
Description of Work:
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Job Address:
Assessor's Parcel Number et'7qt7 I att
Sub.Lot g Block
Earthwork (square leetl= ?t00/ Earthwork (cubic Yards)
ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
NOTICE
Authorltv. This application for a Building Permit must be signed by the Owner of the property, described above, or
anauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthbrity,signedbythe
Owner, must be provided with this Applicatiorr.
Lesal 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 Wasteu/ater Discharge Permit.
VoidPermit. ABuildingPermitbecomesnull andvoidiftheworkauthorizedisnotcommencedwithinl80daysof
the date of issuance and if work is suspcndcd or abandoned for a period of 180 days after commencement.
CERTIFICATION
I hereby certify that I have read this Application, and that the information contained above is true and correct. I
understand that the Buildirrg Divisiorr 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 construct the structure(s) and facilities detailed on the submittals rcvicwcd by thc
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 (County Regulation(s)). All County 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, if the location, construction or use of
the 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
frrrther acknowledge that the issuance of the Building Permit doeE not prcvcnt thc Building Official from: (1)
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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 Regulations
rest with me and my authorized agents, including without limitation my architect designer, engineer and/ or
builder.
I hereby acknowl edge that I have read and understand the Notice and Certification above as well as
havg provided the required information which is correct and accurate to the best of my knowledge.
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P Owner Print Date
OFFICIAL USE ONTY 'ql I
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Brlance dueJ.y Grading Pcrmit
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lssue Date:Zoning:
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6-z-zsBUILDING / PLANNING DIVISION:
Date