HomeMy WebLinkAboutApplicationGaffield County
T
il ;i ..r o nnlP8 8th Street, Suite 401J{'r- r'- J G[Hiiwood Springs, CO 81601
fff'"r' i-i[:l-i ; r .,.. ,. ': (9701 945'8212
[ ( i tr'1 i,f i J ]; j i I' y I ; i, r,' ;,wwtu,.pa rf ieldcou ntvco. gov
rdf:hity Development Department
SS 6-
Engineer:
Mailing Address:0 b
WPE OF GRADING
tr MAJOR ![ rutruon
i *-Ll*^-r-F! LI I! I€EJE'Fhe;:e; fu €fa*
Mailing Address:
Email Address:€.,@
0
,C:r n'r,
Phone:
ytn
o
Ib
EmailAddress:w;ll @evo Vu|*rucf.
INVOTVED PARTIES
D
I
Phone: (qqb )t54qr -
EmailAddress:
Property Owner:
Mailing Address:
)v \nn lA T\Phone:
5
a nrtn h W
eontractor:
Mailing Address:
EmailAddress:
PROIICT NAME ANS LOCATION
Project Name:
Date of Completion:
Description of Work:D.
AL\r rese-
Job Address:C4 r s D b
Itr ,\J 2rI
Assessor's Parcel Number 5
Sub.l4 Ran Lot 1l^Block
Earthwork {square feet}:DO Earthwork (Cubic Yards):
ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING
, NOTTCE
Auihoriiv. inis appiieation ibr a Buiioirrg Perrnit rnust be signed Ery ti'ie Owner oi ihe property, ciescribeo above, or
an authorized agent. lf the signature below is not that of the Owner, a separate letter of authority, signed by the
Owner, must be provided with this Application.
Legal 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. Multi ple separate permits may be required: (1) State Electrical Permit, (2) County OWTS Permit,
iJi a nocner perm ii req u ireci ior use otr rhe pt oper iy ieien irireei abuve, e.B. Sia Le or Lou n r.y H ign'wayli iroiiei access oi
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
| | ; rla !! ! ! !i ilEieai i€iriiy ri-rAi i frAve fgaLi iili5 AppiiCafion, ailJ !il-I rte iilTOiirluiiuri LuiiLciiirEC aOCVE ii Li uc {ii:u LUi rtLi.. 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
!viiriyiuivi:iijiirijrEjiiirsU€idirsrciLrruiiiiji.ciiiciviriLB,ijidtiiiE,Lii€stijii\arrui;i!ud'iicrijLuuiiat-UiiuiildL-Ca,vUtii
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
Buildlng 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.
iar-i-uyE,idiiLFr-rraai5Jrsiiiuari=GuiauiriErsiriJauarau-iiaEr !ri-PiuliErLiri;c;rijutrud*ut-ri--:ii:Fci.i-t_i:-irTuli\. 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 (21stopping construction
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
n:.r.-^e ! --1.--=1,!--l-- +!:=i r+r-.rr.r!h!!it..:{.+r _.r--li---- !"';+L r^i^-^l -:-+^ --f l-^-r r-,.,^ -^J .+!.r-=+--! ^-=-,,!-!i-,-rU'vAiiEi, i dLiiiiUvEi-U€,- LiaFi i-.-h,UaafiUi,,Ly ,+, Ltaiiijii-iiLE Vq;L;i ;-*=it;r 3t€lE s,iu iULtri i='e1;=.iiU tUUiiit i1-E;-id'r;Uii5
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 wh accurate to the best of my knowledge.
L 0 -o /4^rru^n r::5
Property Owner Print and Sign
USE ONIY
special conditions: S,rr-er.J a,9,g'q*Grtlrg4gl 5 p?{rnla.rC S" <a}.r$(.c5L-
O€ieD 1 DrSf lsFD €Arlg\e$\r: Gp,tO6f--^g1 Tt1A<-^)l*rfl?S62\-}.J 6Z\SKT(fr-bvrLDrr\rc- ?cP+ rf .5 Pe}$O,,-5q,- f2eUr6rt
Permit Fee:
tp/rJrl m Misc Fees:Total Fees:
*trl'r,-'o
Fees Paid:*lt'f).co
@s
dueld
Balance Grading Permit:lssue Date:Zoning:
p
2-3o- 5BUILDING / PLANNING DIVISION: