HomeMy WebLinkAbout4160 Ingalls CourtZ� M
q(60 T;>,,,yIl(s Ct INSPECT
INSPECTION ONLINE FORM: http:/'
INSPECTION RE
Cancellations must be submitted via the online fog
J RECORD
wheatridge.co.us/inspection
LINE: (303) 234-5933
8 a.m. the day of the inspection
Occu anc /T e
Inspections will not be performed ui. . this card is posted on the project site.
"Request an inspection before 11:59 p.m. (midnight) to receive an inspection the following business day."
Inspector Must Sign ALL Spaces pertinent to this project
Foundation Inspections Date Inspector Comments
Initials
Pier
Concrete Encased Ground (CEG)
Foundation / P.E. Letter
Do Not Pour Concrete Prior To Approval Of The Above Inspections
Underground/Slab Inspections Date Inspector Comments
Initials
Electrical
Sewer Service
Plumbing
Do Not Cover Underground or Below/In-Slab Work Prior To Approval Of The Above Insaections
Rough Inspections
Date
Inspector
Initials
Comments
Wall Sheathing
Mid -Roof
Lath / Wall Tie
Rough Electric
Rough Plumbing/Gas Line
Rough Mechanical
Rough Framing
Rough Grading
Insulation
Drywall Screw/ Nail
Final Inspections Date
Inspector
Initials
Comments
Landscaping & Parking / Planning Dept.
Inspections from these entities should be requested
one week in advance. For landscaping and parking
inspections call 303-235-2846. For ROW and drainage
inspections call 303-235-2861. For fire inspections
contact the Fire Protection District for your project.
ROW & Drainage / Public Works Dept.
Floodplain Inspection (if applicable)
Fire Inspection / Fire Protection Dist.
Final Electrical
Final Plumbing
Final Mechanical
Je
Roof
Final Window/Doors
y'
Final Building
NOTE: All items must be completed and approved by Planning, Public Works, Fire and Building before a Certificate
of Occupancy is issued. Approval of the Final Building inspection does not constitute authorization of occupancy.
"For low voltage permits — Please be sure that rough inspections are completed fro- the Fire District and electrical low voltage
by the Building Division.
Occupancy Is Not Permitted Until A C 4 Occupancy Is Issued
Protect This ` Weather
� I � City of Wheat Ridge
r ti
�`. Residential Roofing PERMIT - 201706543
PERMIT NO: 201706543 ISSUED: 08/24/2017
JOB ADDRESS: 4160 Ingalls CT EXPIRES: 08/24/2018
JOB DESCRIPTION: Residential Re -roof to install asphalt shingles - 17 sq (14 sq pitched / 3
sq flat)
*** CONTACTS ***
OWNER (303)726-1939 WISNIEWSKI JEFFREY R
SUB (303)827-1607 Ian Armstrong 150072 Planet Roofing & Solar
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 8,250.00
FEES
Total Valuation 0.00
Use Tax 173.25
Permit Fee 188.45
** TOTAL ** 361.70
*** COMMENTS ***
*** CONDITIONS ***
Effective December 1, 2014, asphalt shingle installations require an approved midroof
inspection, conducted when 25-75 percent of the roof covering is installed, prior to final
approval. Installation of roof sheathing (new or overlay) is required on the entire roof
when spaced or board sheathing with ANY gap exceeding one half inch exists. Sheathing and
mid -roofs may be called in at the same time, one hundred percent of the sheathing must be
complete and 25-75 percent of the mid -roof may be complete. Asphalt shingles are required
to be fastened to the roof deck with a minimum of 6 nails per shingle. Ice and water shield
is required. Eave and rake metal is required. A ladder extending 3 feet above the roof eave
and secured in place is required to be provided for all roof inspections. Roof ventilation
is required to comply with applicable codes and/or manufacturer installation instructions,
whichever is more stringent. In order to pass a final inspection of elastomeric or similar
type roof coverings, a letter of inspection and approval from the manufacturer technical
representative stating that "the application of the roof at (project address) has been
applied in accordance with the installation instruction for (roof material brand name)
roof covering" is required to be on site at the time of final inspection.
Roof inspections for ROOFS OVER 6/12 PITCH: 3rd party inspection will be required, the 3rd
party inspection report will be collected at final roof inspection performed by City of
Wheat Ridge. If report is not available the final inspection will not be completed.
„ ' City of Wheat Ridge
Residential Roofing PERMIT - 201706543
PERMIT N0: 201706543 ISSUED:
JOB ADDRESS: 4160 Ingalls CT EXPIRES:
JOB DESCRIPTION: Residential Re -roof to install asphalt shingles
sq flat)
08/24/2017
08/24/2018
17 sq (14 sq pitched % 3
I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications,
applicable building codes, and all applicable municipal codes, policies and procedures, and that I am the legal owner or have been authorized
by the legal owner of the property and am authorized to obtain this permit and perform the work described and approved in conjunction with
this_permrt. I further attest that I am le ally authorized to include all entities named within this document as parties to the work to be
performed and tbata.Iwark'to cument and/or its' a , ompan ,ing approved plans and specifications.
l
Signature of OWNER or CONTRACTOR (Circle one) Date 11
1. This permit was issued based on the information provided in the permit application and accompanying plans and specifications and is
subject to the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures.
Z. This.permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and
received prior to the date of expiration. An extension of no more than 180 days made be granted at the discretion of the Chief Building
Official and may be subject to a fee equal to one-half of the originalpermit fee.
3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard
requirements, fees androcedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of
the Chief Building Official and is not guaranteed.
4o No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval.
5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required
inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services
Division.
6. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, an violation of any provision of any
applicable,&akor any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection.
Signature of Chief Building Official 'a” Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
Dane Lovett (0 706�g3
From: no-reply@ci.wheatridge.co.us
Sent: Tuesday, August 22, 2017 11:05 AM
To: CommDev Permits
Subject: Online Form Submittal: Residential Roofing Permit Application
Follow Up Flag: Follow up
Flag Status: Completed
Residential Roofing Permit Application
This application is exclusively for new permits for residential roofs and for licensed
contractors only. This type of permit is ONLY being processed online --do not come
to City Hall to submit an application in person. Permits are processed and issued in
the order they are received and due to the volume of requests, time to process
varies and is subject to change. YOU WILL BE CONTACTED WHEN YOUR
PERMIT IS READY FOR PICK-UP AND WILL BE GIVEN A SPECIFIC DATE
AND TIME WINDOW TO COMPLETE THE TRANSACTION. You will be notified if
your contractor's license or insurance has expired, and you may update those
documents at the time you are issued your permit.
For all other requests:
Homeowners wishing to obtain a roofing permit must apply for the permit in person
at City Hall. Revisions to existing permits (for example, to add redecking) must be
completed in person at City Hall. All other non -roofing permits must be completed in
person at City Hall. The Building Division will be open from 7:30-10:30 a.m.,
Monday through Friday to process these types of requests.
THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN
REROOFING UNTIL PERMIT HAS BEEN ISSUED.
Is this application for a Yes
residential roof?
How many dwelling units Single Family Home
are on the property?
PROPERTY INFORMATION
Property Address 4160 Ingalls Ct
Property Owner Name Jeff Wisniewski
Property Owner Phone 303-726-1939
Number (enter WITH
dashes, eg 303-123-4567)
141
E
Property Owner Email
Address
Do you have a signed
contract to reroof this
property?
Applications cannot be
submitted without an
executed contract
attached below.
Attach Copy of Executed
Contract
Field not completed.
Yes
2017-08-22 10-53-24.pd
CONTRACTOR INFORMATION
Contractor Business Planet Roofing and Solar
Name N✓
Contractor's License 150072
Number (This is a 5 or 6
digit number for the City
of Wheat Ridge)
Contractor Phone
Number (enter WITH
dashes, eg 303-123-4567)
Contractor Address
(Primary address of your
business)
720-245-0849
1695 W Sheri Lane Littletone CO 80120
Contractor Email Address mike@planetroofingcolorado.com
Retype Contractor Email mike@planetroofingcolorado.com
Address
DESCRIPTION OF WORK
TOTAL SQUARES of 17
the entire scope of work:
Project Value (contract (550
value or cost of ALL
materials and labor)
Are you re -decking the No
roof?
142
Does the scope of the
project include a flat roof
(less than 2:12 pitch)?
How many squares are
part of the flat roof?
Describe the roofing
material for the flat roof:
Type of material for the
flat roof:
Does the scope of the
project include a pitched
roof (2:12 or greater
pitch)?
How many squares are
part of the pitched roof?
Describe the roofing
materials for the pitched
roof:
Type of material for the
pitched roof:
Provide any additional
detail here on the
description of work. (Is
this for a house or
garage? What is the roof
pitch? Etc)
Yes `
3
Certainteed Northgate Modified Bittiment
Rolled
Yes
14
Certainteed Northgate
Asphalt
House only
SIGNATURE OF UNDERSTANDING AND AGREEMENT
I assume full
responsibility for
compliance with
applicable City of Wheat
Ridge codes and
ordinances for work
under any permit
issued based on this
application.
I understand that this
application is NOT a
permit. I understand I will
be contacted by the City
Yes
Yes
143
to pay for and pick up the
permit for this property.
I understand that work Yes
may not begin on this
property until a permit
has been issued and
posted on the property.
I certify that I have been Yes
authorized by the legal
owner of the property to
submit this application
and to perform the work
described above.
I attest that everything Yes
stated in this application
is true and correct and
that falsifying
information in this
application is an act of
fraud and may be
punishable by fine,
imprisonment, or both.
Name of Applicant Mike Walthers
Email not displaying correctly? View it in your browser.
144
Iu V Littleton Co 80120
3038271607
orww.Planetroofin2coloi-ado.com
Info@planetroofingcolorado.com
Customer Name Date Work Order #
_ t
Address% �� a is City _State zip SC//
Home(%' 7 1937 Work( ) Email
R',";3 drag`
Designer Impact Resistant
Shingle
Tear off all layers of roof covering
_ '/i CDX lay over existing ( if
required by code
_ Install decking (7/16"osb) as
needed per code
_ Install new underlayment
_ Install pre -painted eve metal to
code
_ Install new flashings
Replace all vents
_ Re- Flash chimneys and all wall
abutments
_ Remove all debris resulting from
above work
Clean out gutters
_ Make a magnetic sweep for
removal of any nails
_Permit
_ 10 year workmanship warranty
_50 Year Manufacture warranty
Optional cost above insurance
adjustment
e„ Sndard Impact Resistant Shingle
Tear off all layers of roof covering
'/z CDX lay over existing ( if
equired by code
stall decking (7/16"osb) as
heeded per code
Install new underlayment
stall pre -painted eve metal to
ode
) %imtall new flashings
CReplace all vents
Re- Flash chimneys and all wall
utments
t� Remove all debris resulting from
above work
Clean out gutters
Make a magnetic sweep for
emoval of any nails
Permit
year workmanship warranty
�0 Year Manufacture warranty
Optional Cost above insurance
Install Date
Estimated time of completion -LZ
z a:
Standard Shingle
_ Tear off all layers of roof
covering
_ '/2 CDX lay over existing ( if
required by code)
_ Install decking (7/16"osb) as
needed per code
_ Install new underlayment
_ Install pre -painted eve metal to
code
_ Install new flashing, vents,
chimney and all wall abutments as
needed or per coverage by insurance
_ Remove all debris resulting from
above work
_ Clean out gutters
Make a magnetic sweep for
removal of any nails
_Permit
_ 1 Year Workmanship Warranty
30 Year Manufacture warrantv
Service Chosen _
Color of Shingle
Color of Flashing
All color choices are final and subiect to
Additional cost if changed/k/ Initial
Additional Items
Planet roofing and solar will not pay, waive, or rebate all or part of any insurance deductible applicable to the insurance claim. Propert�� o er attest that
Planet roofing and solar has not promised or agreed to pay, waive, or rebate all or part of any insurance deductible in any form 4� initial
Payment Process: Initial payment or ACV check is due after start of construction along with any necessary deductible needed to be
collected. The final payment or RCV check is due after completion of construction along with any optional cost of upgraded systems.
Planet roofing and solar will collect all proceeds in accordance to surance company agreed scope of loss and any additional
supplements awarded p Initial
Initial Paymenta�7 c ( Deductible =
Final Payment/' 3, 6 r� Optional Cost
-'
Company ApprovalA ! Date �Pl
Customer Approval Date .�
i CITY OF WHEAT RIDGE
Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office - (303) 237-8929 Fax
INSPECTION NOTICE
❑ No one available for inspection: Time
Re -Inspection required: Yes No
When corrections have been made, call for
(.
Date: Inspector
AM/PM
at 303-234-5933
f
i CITY OF WMEAT RIDGE
Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: E 0 Aec /'
Job Address: _Z/V,�_ it 6 -
Permit
Permit Number:
❑ No one available for inspection: Time AM/PM
Re -Inspection required: Yes r Nod
When corrections have been made, call for re -inspection at 303-234-5933
Date: F' Inspector:
DO NOT REMOVE THIS NOTICE,
N* i CITY OF WHEAT RIDGE
_1�9rBuilding Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: ����'' ' 4 f�. •� I
Job Address: { t 'S
Permit Number:
ct) 12e
v n,1 eo
P .
ti� hr�
Joe -
i
No one available for inspection: Time 3'y AM/PM
Re -Inspection required: Ved No
When corrections have been made, call for re -inspection at 303-234-5933
, J
Date: I �`"� -
Inspector:
��`
N
DO NOT REMOVE THIS NOTICE
FOR `ICE USE ONLY
City
DOW
j�d
-
of
COMMUNITY DEVELOPMENT t PlilwP+ it 'f Nit tk t o
Building & Inspection Services Division
7500 W. 2e ;Ave,, Wheat Ridge, CO 80033 Placa Reviews Fee.
Once: 303-235-2855 * ex: 303-237-8929
Inspection Lime; 303-234-5933
rnail:errrsits c .wheetri i e. o.us
Building r tt Application
Please complete all highlighted areas on both sides of this form. Inmnplate applications May not sed.
Property Address: T
Property Owner (please print): J > Phone;
Property Owner ail.
ailin Address: (it different than property address)
Address;
Ci!Y, Mete, Zip:
Architect/Enginser E-mail.- Phone.*
Contractor: �
Contractors City i nse Phonq. �
Contr ct all Address.
Sub contractors:
Electrical. Plumbing: Mechanical:
W.R. City License # W.R. City License # W.F. City License #
Other City Licensed Sub: Other City Licensed Sub:
City License # City License #
Complete all information on BOTH sidles of this for
COMMERCIAL tTRESIDENTIAL
tic tt wc. k: (Check all that apply)
0 NEW COMMERCIAL STRUCTURE ELECTRICAL SERVICE UPGRADE
NEW RESIDENTIAL STRUCTURE COMMERCIAL ROOFING
COMMERCIAL ADDITION RESIDENTIAL ROOFING
RESDENTIAL ADDITION WINDOW REPLACEMENT
COMMERCIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.)
RESIDENTIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.)
MECHANICAL SYSTEM/APPLIANCE REPAIR or REPLACEMENT
PLUMBING SYSTEM/APPLIANCE REPAIR or REPLACMENT
ELECTRICAL SYSTEM/APPLIANCE REPAIR or REPLACEMENT
OTHER (Describe}
fc— At 1,«...,,......«.a.. .:l.. .........,.. ,c...€... ,. ...r. r.� .t,.,.....,...ss..«..,. ...d .......i. a...k i .. ... y..e....,......a ...«.iaw#`•w.w ;wr aaw»s rsk .ac+ca swF +!awea++
mount tit materials to be used, etc.)
Sq. FULF Btu's gallons
Amps Squares Other
p INSPECTION RECORD
INSPECTION REQUEST LINE: (303) 234 -5933
Inspections will not be performed unless this card is posted on the project site.
Call the inspection request line before 3:00 p.m. to receive an inspection the following business day.
Inspector Must Sign ALL Spaces pertinent to this project
Foundation Inspections Date 11 Imt�als I Comments
Monolithic Slab Reinforcement
Caissons
Concrete Encased Ground (CEG)
Footing /Stemwall P.E. Letter
Do Not Pour Concrete Prior Tn Annrnval Of ThP Ahnvp Incnoc +inns
Underground /Slab Inspections
Date
Inspector
Initials
Comments
Electrical (Underground)
Sewer Service (Underground)
Water Service (Underground)
Date
Inspector
Comments
omments
Plumbing (Below/ In -slab)
Heating (Below/ In -slab)
uo NOT Loover underground or 13elow /ln -Slab work Prior To Approval Of The Above Inspections
Rough Inspections Date Inspector Comments
omments
Wall Sheathing
Roof Sheathing
Lath /Wall Tie
Rough Electric
Rough Plumbing
Rough Mechanical
Gas Piping
Do Not Proceed Without Approval Of Above Rough Inspections
Insulation
Drywall Screw / Nail
Final Inspections
Date
Inspector
Comments
omments
Final Electrical
Final Plumbing
Final Mechanical
Roof
Final Building / Frame
Landscaping & Parking / Planning Dept.
Inspections from these entities should be requested
one week in advance. For landscaping and parking
inspections call 303 - 235 -2846. For ROW and drainage
inspections call 303 - 235 -2861. For fire inspections
contact the Fire Protection District for your project.
ROW &Drainage /Public Works Dept.
Fire Inspection / Fire Protection Dist.
"`Note: All items must be completed and approved by Planning, Public Works, Fire and Building before a Certificate
of Occupancy is issued. Approval of the Final Building inspection does not constitute authorization of occupancy.
Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued
Protect This Card From The Weather
A 4'
• CITY OF WHEAT RIDGE
Building Inspection Division
(303) 234-5933 Inspection line
(303) 235 -2855 Office (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type
ry
Job Address �{ a 14 14,v-11Y e, 7'
Permit Number 110.7 a
+' CITY OF WHEAT RIDGE
Building Inspection Division
(303) 234 -5933 Inspection line
(303) 235 -2855 Office * (363) 237 -8929, Fax
INSPECTION NOTICE
Inspection Type Y Rom✓'°
Job Address 4 11 /a e4, 7 -
Permit Number '11e)775'
d ` ! ,��, s -ssta
r.a,.�.519,e_ `7 ,.D JIV t Sa 7 7 , as 1
i„
r :
t ❑ No one available for inspection: Time r AM
Vr
Re- Inspection required: Ye - No
when corrections have been made, call for re- inspection at 303- 234 -5933
r t, Date: r/1z// Inspector: c
DO NOT REMOVE THIS NOTICE
City of Wheat Ridge
Residential Roofing PERMIT - 110975
PERMIT NO: 110975 ISSUED: 08/17/2011
JOB ADDRESS: 4160 INGALLS CT EXPIRES: 08/16/2012
DESCRIPTION: Reroof 16 sqs with 30 yr Laminate shingles
* ** CONTACTS * **
owner 720/270 -6222 Kent Nelson
sub 303/853 -0978 Larry Merkel 01 -9620 Larry Merkel Coatings
** PARCEL INFO
**
ZONE CODE:
UA
USE:
UA
SUBDIVISION:
0394
BLOCK /LOT #:
0/
** FEE SUMMARY ** ESTIMATED PROJECT VALUATION: 5,860.00
FEES
Permit Fee 140.90
Total Valuation .00�
Use Tax 105.48
** TOTAL ** 246.38
Conditions:
6 nails per shingle is required. Ice dam membrane is required from eave edge to
2' inside exterior walls. Board sheathing with any gap greater than 1/2"
requires panel sheathing overlay on entire roof. Sheathing inspection is
required prior to covering. Contractor shall provide ladder for inspections.
Scheduled inspections that cannot be performed due to inclement weather must be
cancelled prior to 8:30 a.m. on the day of inspection or a re- inspection fee
will be assessed. Subject to field inspection.
I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and
specifications, applicable building codes, and all applicable municipal codes, policies and procedures, and that I am the
legal owner or have been authorized by the legal owner of the property and am authorized to obtain this permit and perform
the work described and approved in conjunction with this permit. I further attest that I am legally authorized to include all
entities named within this document as parties to the work to be performed and that all work to be performed is disclosed in
this docum an or its' ac 'ng approved plans and specifications.
Signature f CT (Circle one) Date
1. This permit was issued based on the information provided in the permit application and accompanying plans and
specifications and is subject to the compliance with those documents, and all applicable statutes, ordinances,
regulations, policies and procedures.
2. This permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must
be made in writing and received prior to the date of expiration. An extension of no more than 180 days made be granted
at the discretion of the Chief Building Official and may be subject to a fee equal to one- half of the original permit fee.
3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to
the standard requirements, fees and procedures for approval of any new permit. Re- issuance or extension of expired
permits is at the sole discretion of the Chief Building Official and is not guaranteed.
4. No work of any manner shall be performed that shall results in a change of the natural flow of water without prior
and specific approval.
5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy
of all required inspections and shall not proceed or conceal work without written approval of such work from the
Building and Inspection Services Division.
G. The issuance or granting of a permit shall not be construed to be a permit for, or an approval of, any violation of
any provision of applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subject
to field 'ns c
Signature o Chi Building Offical Date
INSPECR`ION REQUEST LINE: (303)234 -5933 BUILDING OFFICE: (303)235 -2855
REQUESTS MUST 13E MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
City of
�' �� 1C Date:
�ommuN[TY DEVELOPMENT
Plan #
Building & Inspection Services Division Pernfit #
7500 W. 29" Ave., Wheat Ridge, CO 80033
Office: 303 - 235 -2855 * Fax: 303 - 237 -8929
Inspection Line: 303- 234 -5933
Building Permit Application
Property Address: 4
Property Owner (please print): E A)f— ( Son Phone: 7; 7 Q 2 Z 2
Mailing Address: (if different than property address)
Address:
City, State, Zip:
Contractor:
Contractors City License #:
S u b'Contract_o_ rs_
Electrical:
City License #
Plumbing:
City License #
Phone: X 03- ?/d
3 S U
Mechanical:
City License #
Ye2Mou e G )c iY-,r5 t—" o Contract Value:
S (1 3� t, c, r ,t��. �e y� 2 $ SSlen ed
Review Fee (due at time of submittaq:
Squares BTU's Gallons Amps Sq Ft. $
OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT
I hereby certify that the setback distances proposed by this permit application are accurate and do not violate, applicable ordinances,
rules or regulations of the City of Wheat Ridge or covenants, easements or restrictions of record; that all measurements shown and
allegations made are accurate; that I have read and agree to abide by all conditions printed on this application and that .I assume full
responsibility for compliance with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on
this application; that I am the legal owner or have been authorized by the legal owner of the property to perform the described work
and am also authorized by the legal owner of any entity included on this application to list that entity on this application.
CIRCLE ONE (OWNER) (CONTRACTOR) or (AUTHORIZED REPRESENTATIVE) o f (OWNER) (CONTRACTOR)
-T-6 Pekersa� / f?
_ PRINT NAME: YV� SIGNATURE: DATE:
,bGtlll b`TII� #CAIYtIQC %\ \It Y/. �Y.
rupuiu VVVrtnJ UUmMCnW VVVVYg1VVT
" Reviewer -
FIRE DEPARTMENT Q approved W/ COIJImBnts D ftlS2ppfoyed %no I�eViBW,regUlreJl 81dg Valuation. $