HomeMy WebLinkAboutApplicationGurjield County
Community Development Department
108 8s Street, Suite tCIl
Glenwood Springs, CO 81601
(970194s{212
www.garfi eldcou nWco.gov
TYPE OF GRADING
E] MAJOR E MINOR
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Phone: ilN, ZSLtrnZContractor:
Mailing Address:
Email Address:
Proiea Name:Qrr .lAL ? )
Date of Completion:fu* -{--.,}
Description of Work:C{..'rrc^*r o tll -'C C,,.--I.^ l-'
INVOTVED PARTIES
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Email Address:
Propefi Owner:
Mailing Address:
Phone:r170r
r17o tEngineer:
Mailing Address
Email Address:
Architect:
Mailing Address:
EmailAddress:
PROJECT NAME AND TOCATION
Job Address:
Assessor's Parcel Number:t Dz-l
Sub.Lot ?t Block
Earthwork (square feetl:
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Earthwork (Cubic Yardsl:
ALL UTILITIES MUST BE TOCATED PRIOR TO ANY GRADING
NOTICE
Authsrilv. This applicatlon for a Duilding Pernrit rrrusl bc signcd by the owner ofthe property, descrihed ahnve, or
an authorized agent. lfthe signature below is notthat ofthe Owner , a separate letter of authority, signed by the
Owner, rrtusl lre pruvirjetJ wil.lr Llris Application.
Legal Access. A Building Permit cannot be issued without proof of legal and adequate access to the propefty fOf
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 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 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 Building Division 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 reviewed by the
Building Division. ln consideration of the issuance of the Building Permit, I agree that I and my agents will comply
with pr.ovisions of any federal, statq or local law regulating the work and the Garfield Countv 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
further acknowledge that the issuance of the Buiiding Permii does not prevent the Building Official from: (1)
requiring the correction of errors in the submittais, if any, discovereci atter issuance; or (2i stopping construfiion
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 acknowledge that I have read and understand the Notice and Certification above as well as
have provided the required information which is correct and accurate to the best of my knowledge.
Catherine Kenworthy CJLt -- 7t2t2s
Property Owner Print and Sign Date
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P€rmit Fee:$M.6 Misc Fees:
N)/A '",{i'67).oo fi"i{ii:*
Balanee due:
$d.e
Gradiig Permit:lszue Date:Zonlng:9rlD
-7 -3 -25
DateSigned
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