The URL can be used to link to this page

Home My WebLink About6395 W. 47th Avenuei CITY OF WHEAT RIDGE Building Inspection Division (303) 235-2855 Office INSPECTION NOTICE Inspection Type: Job Address: �f; �' ! �f +' 1 A✓ �- Permit Number: m. t ❑ No one available for inspection: Time 1 Ute AM/PM Re -Inspection required: ties No When corrections have been made, schedule for re -inspection online at: http✓/www.ci. wheatridge.co. us4inspection Date: `L Inspector: ®O NOT REMOVE THIS NOTICE City of Wheat Ridge Homeowner Interior Remodel PERMIT - 201902000 PERMIT NO: 201902000 ISSUED: 09/24/2019 JOB ADDRESS: 6395 W 47th Ave EXPIRES: 09/23/2020 JOB DESCRIPTION: Creating bedroom and closet by constructing wall in living room; add receptacle in closet - 144 sq ft total *** CONTACTS *** OWNER (720)298-6560 RODRIGUEZ ROY *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 2,939.00 FEES Total Valuation 0.00 Plan Review Fee 60.68 Use Tax 61.72 Permit Fee 93.35 ** TOTAL ** 215.75 *** COMMENTS *** *** CONDITIONS *** I, the property owner, by my signature, attest that I currently reside at the project property, intend to reside at the property for a period of one year after completion of the project, and am personally performing all work, without the assistance of hired or professional workers. If professionals are hired, those contractors are licensed with the City of Wheat Ridge and are listed on the permit. NOTE: Consultations and inspections will only be performed with the homeowner of record present. All roughs to be done at Framing Inspection. Approved per plans and red -line notes on plans. Must comply with 2012 IRC, 2017 NEC and all applicable City of Wheat Ridge Municipal Codes. Work is subject to field inspections. City of Wheat Ridge 100010 Homeowner Interior Remodel PERMIT - 201902000 PERMIT NO: 201902000 ISSUED: 09/24/2019 JOB ADDRESS: 6395 W 47th Ave EXPIRES: 09/23/2020 JOB DESCRIPTION: Creating bedroom and closet by constructing wall in living room; add receptacle in closet - 144 sq ft total 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 ermrt. I further attests at I am ally authorized to include all entities named within this document as parties to the work to be performed and that all wdrk be per rm�,�d�s disclosed in this document and/or its' accompanying approved plans and specifications. +. \moi -2&(-1I Signature of OWNER or CONTRAgT,'OR (Circle one) Date I . This permit was issued based on the information provided in the permit application and accompanyingpplans 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 originalpermit fee. 3. If this pen -nit 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 Budding Official and is not guaranteed. 4, No work of an manner shall be performed that shall results in a changeof 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 n9t be construed to be a permit for, or an approval of, an violation of any provision of any r�t'n applicable code or any oapce or regulatiop of this jurisdiction. Approval of work is subject to field inspection. Signature of Chief Building Official ` Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. �• City of Wh6taj1L'(S:11 e COMMUNITY DEVELOPMENT Official Certification of Property Owner Permit THIS 15 TO CERTIFY that I, the property owner, by my signature, attest that I currently reside at the project property, or intend to reside at the property for a period of one year after completion of the project, and am personally performing all work, without the assistance of hired or professional workers, or, if hiring sub -contractors, list them on the permit. Consultations and inspections will only be performed with the homeowner of record present at the project property. Property Owner(s): 2 o I��t7 C�vi ! v2 �. Project Property: Ae. LQ , -J j& 6� �ya Project Type: 5�� /��./�ry �ar�� c✓��/� nv,� f�°'�f�` Notarized signature of Applicant State of Colorado } County of 5L4S r , } ss The foregoing instrument was acknowledged by me this day of -5y , 20JJ_ by TAMARA D ODEAN NOTARY PUBLIC STATE OF COLORADO NOTARY ID 20164015481 MY COMMISSION EXPIRES APRIL 22, 2020 f�U My Commission Expires —!L/—Z-?20 24 Notary Public .ell�6P-tel' (r�WJ�w -P F-T� C)U) i D(M T— 5?3 I ' C�V�r=3C �, nj/� i 7A i A + i i-A r ' �__ ` I r City of I !' �, C.UMMUNI JY DLVLLUI'MiPi 1'— APPROVED �evie d for Code Compliance JIq Plans c.aminer Date ••� -- I pemr CDP IPw Pec,ficotiora Vali of permit: �h! usuanct o o /t w rovoJ o ns s t— and Mr, un,ryons shall not be C pe7mjtjbr, or an opproval of, any vrofohon to i any Cf the P-ws,ons of Me bu,Niinq We 01 of air City orononces. Pormft Pr/mumng to give authority to vOW# or concel the prov stops of thf WifdkMp COM Or other MWTWM Offt aty SW not be slid. I AbL WOE rTO CbM/lu� w M/ IN, OA1*1 I ✓_ CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: COU- C 0 V r- )-e 9V Job Address: (0 3 q S-- y) y fh Permit Number: ❑ No one available for inspection: Time'/ - S-3 M M Re -Inspection required: Yes No When corrections have been made, call for re -inspection at 303 -234 - Date: --7 1/0 Inspector: —i D DO NOT REMOVE THIS NOTICE I . 0, 1 le City of Wheat Ridge lr�9r Homeowner Roof PERMIT - 201706441 PERMIT NO: 201706441 ISSUED: 08/23/2017 JOB ADDRESS: 6395 W 47th AVE EXPIRES: 08/23/2018 JOB DESCRIPTION: Permit for Homeowner re -roof: Remove existing roofing material, replace with new 30 year shingles. 25 squares *** CONTACTS *** OWNER (402)984-1290 RODRIGUEZ ROY *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PRQ•.ECT VALUATION: 6,500.00 FEES Total Valuation 0.00 Use Tax 136.50 \ Permit Fee 156.75 ** TOTAL ** 293.25 *** COMMENTS *** *** CONDITIONS *** I, the property owner, by my signature, attest that I currently reside at the project property, intend to reside at the property for a period of one year after completion of the project, and am personally performing all work, without the assistance of hired or professional workers. Consultations and inspections will only be performed with the homeowner of record present. 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 Homeowner Roof PERMIT - 201706441 PERMIT NO: 201706441 ISSUED: 08/23/2017 JOB ADDRESS: 6395 W 47th AVE EXPIRES: 08/23/2018 JOB DESCRIPTION: Permit for Homeowner re -roof: Remove existing roofing material, replace with new 30 year shingles. 25 squares I'by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications, applicable tuilding codes, and all applicable municipal codes, policies and procedures, and that [ 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 thatA am legally authorized to include all entities named within this document as parties to the work to be performed acrd at a k le performed is disclosed in this document and/or its' accompanying approved plans and specifications. r../ 1 ;n ure of OWNER or CNTkACTOR (Circle one) Oate 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. 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. 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��pprocedures 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. No work of any manner shall be performed that shall results in a change of the natural flow of water without prior andspecific approval. 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. The issuance or granting of a permit shall not be construed to be a%p,,. , or an approval of, any violation of any provision of any applicable code or any ordinance or regulation of this jurisdiction.of work i ct to field inspection. Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. City of Wheat i c IT COMMUNY DEVELOPMENT Official Certification of Property Owner Permit THIS IS TO CERTIFY that I, the property owner, by my signature, attest that I currently reside at the project property, or intend to reside at the property for a period of one year after completion of the project, and am personally performing all work, without the assistance of hired or professional workers, or, if hiring sub -contractors, list them on the permit. Consultations and inspections will only be performed with the homeowner of record present at the project property. Property Owner(s): Project Property: L-aags- W, 44= Notarized signature of Ap State of Colorado } County of 14ESS The foregoing instrument was acknowledged by me this '2,5 day of OAAQISS 20-U by v JAYMESUE MCR IMMON NOTARY PUBLIC STATE OF COLORADO NOTARY ID # 20154009457 MY COMMISSION EXPIRES MARCH 06, J2019 My Commission Expires0 /__&_J20 j9 City of W heat j , dge COMMUNITY DEVELOPMENT Building & Inspection Services Division 7500 W. 291h Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 Inspection Line: 303-234-5933 Email: permits(D_ci.wheatridge.co.us FOR OFFICE USE ONLY Date: �I Plan/Permit # Z0I-) howl Plan Revi w Fee: Building Permit Application *** Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. **" Property Address: A,?S— k/ 1-17 A -y -e - Property Owner (please print): /20 y Re ".c 2 Phone: Property Owner Email: r od z _ r4l V 041 Mailing Address: (if different than property address) Address: City, State, Zip: Architect/Engineer: Architect/Engineer E-mail: Contractor: Contractors City License #: Contractor E-mail Address: Sub Contractors: Electrical W.R. City License # Other City Licensed Sub: City License # Plumbing: W.R. City License # Phone: Phone: Other City Licensed Sub: City License # Mechanical: W.R. City License # Complete all information on BOTH sides of this form ❑ COMMERCIAL ❑ RESIDENTIAL Description of work: (Check all that apply) ❑ NEW COMMERCIAL STRUCTURE ❑ ELECTRICAL SERVICE UPGRADE ❑ NEW RESIDENTIAL STRUCTURE ❑ COMMERCIAL ROOFING ❑ COMMERCIAL ADDITION J�rZESIDENTIAL 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) (For ALL projects, please provide a detailed description of work to be performed, including current use of areas, proposed uses, square footage, existing condition and proposed new condition, appliance size and efficiency, type and amount of materials to be used, etc.) !� Ne, .5 C% r /ti, Sq. FULF =� 0'v Btu's Amps Squares Gallons Other Project Value: (Contract value or the cost of all materials and labor included in the entire project) OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT 1 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. 1, the applicant for this building permit application, warrant the truthfulness of the information provided on the application. CIRCLE ONE: (OWNER) (CONTRACTOR) or (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR) Signature (first and last name): DATE: 7il 2-Z I I ZONING COMMMENTS: Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: DEPARTMENT USE ONLY OCCUPANCY CLASSIFICATION: Building Division Valuation: $ i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: 3 016 A/70 Job Address: 63 967 W y 7 -t Permit Number: ?,ol70 (o qy ❑ No one available for inspection- Timeu"" J `� AM/PM Re -Inspection required: Yes oNo When corrections have been made, call for re -inspection at 303-234-5933 Date: 9 //7 Inspector: rh / r7 DO NOT REMOVE THIS NOTICE City (A COMMUN I IY DL ENT 0 • Building Permit Application (Complete #11 highlighted areas) ji I Sic .4 4 _vt- OAJ4 'S 1 • Ivey'a P15 i Vote: ' 4"** Plan # Permit # =' MMM City License # City License # City License # FIRE M « + r City of Wheat Ridge .� Faxed Plumb. Permit PERMIT - 111018 PERMIT NO: 111018 ISSUED: 08/24/2011 JOB ADDRESS: 6395 W 47TH AVE EXPIRES: 08/23/2012 DESCRIPTION: Replace 40 gallon hot water heater * ** CONTACTS * ** owner 402/984 -1290 Patricia Sundberg sub 866/898 -0008 Mariana Kitchukova 08 -0021 Colorado Delta Mechanical Inc. ** PARCEL INFO ** ZONE CODE: UA USE: UA SUBDIVISION: 0367 BLOCK /LOT #: 0/ ** FEE SUMMARY ** ESTIMATED PROJECT VALUATION: 913.00 FEES Permit Fee 40.00 Total Valuation .00 �. Use Tax 16.43 ** TOTAL ** 56.43 Conditions: Both front and back of permit need to be posted on job site. If one or the other is not present, INSPECTION WILL NOT BE PERFORMED. Work shall comply with 2006 IRC & 2005 NEC. Per IRC Sec. R313, smoke detectors are required to be installed in every sleeping room, in hallways outside of sleeping rooms, and on every level of the structure. Carbon Monoxide detectors are required to be installed within fifteen(15) feet outside the entrance to each sleeping room. 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 document and /or its' accompanying approved plans and specifications. .Signature of OWNER or CONTRACTOR (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. 6. 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 any applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field sp Loon. Signatu W of 01 ef Building Offical Date INSP REQUEST LINE: (303)234 -5933 - BUILDING OFFICE: (303)235 -2855 REQUESTS MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. �� 0 lilo�g INSPECTION RECORD Occupancy /Type INSPECTION LINE: (303) 234 -5933 pections will not be made unless this card is posted on the building site Call by 3:00 PM to receive inspection the following business day. g U INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS .JOB FOUNDAECTIONS t DATE INSPECTOR INITIALS COMMENTS: Footings / --. —_. --- -._ _..--- --- - -- --- — l Service lectric RM lumbing Stemwall oncrete Encased echanical ABOVE INSPECTIONS TO BE SIGNED PRIOR TO PROS CITY OF WHEAT RIDGE Framing 08/24/11 1 :35 Phi cdbb Reinforcinolithic Drywall Screw RECEIPT 140:CDR006520 ANOUNT DPSP Replace 40 gallon no 56.43 Weatherpch Drain Permit Fee 40.00 Electrical Use Tax 46,43 Plumbing Sewer Ses Mechanical VS 3376 56.43 Roof Auth code: 06333`2 Water Service Lines Fire Department ---------------------------------------- R.O.W & Drainage POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED CONCRETE SLAB FLOOR Electrical (Underground) "NOTE: ALL ITEMS MUST BE COMPLETED AND APPROVED BY PLANNING AND ZONING, BUILDING AND PUBLIC WORKS BEFORE A Plumbing (Underground) OFA CERTIFICATE OF OCCUPANCY NOR PERMISSION FOR OCCUPANCY. Heating (Underground) ROUGHS __ -- _... - - -- __ - - -- - g ll tie - --. —_. --- -._ _..--- --- - -- --- — l Service lectric RM lumbing g echanical ABOVE INSPECTIONS TO BE SIGNED PRIOR TO PROS CITY OF WHEAT RIDGE Framing 08/24/11 1 :35 Phi cdbb Insulation Colorado Delta lecha Drywall Screw RECEIPT 140:CDR006520 ANOUNT DPSP Replace 40 gallon no 56.43 FINALS 111012 Permit Fee 40.00 Electrical Use Tax 46,43 Plumbing PAYISEtBT RECEIVED ANOUNT Mechanical VS 3376 56.43 Roof Auth code: 06333`2 Building Final TOTAL 56.43 Fire Department ---------------------------------------- R.O.W & Drainage INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLIC WORKS SHOULD BE CALLED AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS. Parking .& Landscaping "NOTE: ALL ITEMS MUST BE COMPLETED AND APPROVED BY PLANNING AND ZONING, BUILDING AND PUBLIC WORKS BEFORE A CERTIFICATE OF OCCUPANCY IS ISSUED. FINAL INSPECTION BY THE BUILDING DIVISION. DOES NOT CONSTITUTE AUTHORIZATION OFA CERTIFICATE OF OCCUPANCY NOR PERMISSION FOR OCCUPANCY. OCCUPANCY NOT PERMITTED UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED PROTECT THIS CARD FROM THE WEATHER Aug.24. 2011 10:43AM STEVE No. 0822 F. 2 City of ly�?' Wheat�idge Date: M MUNiTyDEVELOPMENT pannit #: Building Division 7500 W. 29 Ave., Wheat Ridge, CO 80033 Office: 303 -235 -2855 * Fax: 303- 237 -8929 Inspection Line. 303 - 234 -5933 (' Facsimile Building Permit Application Property Address to 3 q 5D U0, � � Ni • Property Owner (please print): Ckk 6CG G JkUA& )0 - Malling Address: (if different than property address) Address: 5aYYIp 99 q - 129c) Contractor. License #: 1, ` - a Sub Contractors: Company Name: License #: Expiration Date: Trade /Profession: Anorovai: Use of space (description): dc� Description of work: re picks-e W eIte r h e ate r Plan Review (due at time of submittal): s Sq. FGL.Ftadded: Squares STU's Gallons—q—O—Amps OWNERICONTRACTOR 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 the Wheat Ridge Building Code ((.B,C) and all other applicable Wheat Ridge Ordinances, for work under this pemit Plans subject to field Inspection. CIRLCEONEr. ^ ( ( OOWNER) ' ( ( CONTRAC 1 TOR) or PERSONAL REPR>•S TATIVEof (OWN (C0 TRATOR) (� PRINT NAME: ,1 a II�kC Gv.7 S $ � IGNATURE 1 Date: `�'2 /•1' TONING COMMENTS: Zoning: Reviewer. PUBLIC WORKS COMMENTS: Reviewer. DEPARTMENT USE ONLY BUILDING DEPARTMENT COMMENTS: OCCUPANCY: Reviewer. FIRE DEPARTMENT:: 0 approved wt comments 0 disapproved O no review required Bldg Valuation: $ Credit Card Payment: Use credit card listed on Da signatu � te: 02 y )J Print name: UI ToKruks ��