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HomeMy WebLinkAbout4050 Benton Streeti CITY OF WHEAT RIDGE Building Inspection Division (303) 235-2855 Office �SEIO�NN� Inspection Type: Job Address: c1b Permit Number: 2aact ❑ No one available for inspection: Tim Re -Inspection required: Yes No When corrections have been made, qdh 4** Lqr re -inspection online at: http✓/www.ci.wheatridge.co.usrinspepio ---- ----- ''''� Da;73spectof'tl' City of Wheat Ridge E -Res. Electrical Service PERMIT - 202001393 PERMIT NO: 202001393 ISSUED: JOB ADDRESS: 4050 Benton St EXPIRES: JOB DESCRIPTION: Electrical change, 125 AMPS outdoor panel. *** CONTACTS *** OWNER (920)287-9519 PICKARD JACLYN SUB (303)503-9798 FRANK WOLF 07/24/2020 07/24/2021 018091 SIN JAC ELECTRIC INC *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2412 / LAKESIDE, STEWART GARDENS, OLI BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 3,000.00 FEES Total Valuation 0.00 Use Tax 63.00 Permit Fee 93.35 ** TOTAL ** 156.35 *** COMMENTS *** *** CONDITIONS *** Both the front and back of this permit are required to be posted on the job site at all times. If the complete permit is not present, inspections WILL NOT be performed. Work shall comply with 2018 IRC & 2020 NEC. Smoke alarms shall comply with 2018 IRC Section 134. Interior alterations, repairs, fuel -fired appliance replacements, or additions, any cf which require a building permit, occurs or where one or more rooms lawfully used for sleeping purposes shall have an operational carbon monoxide alarm installed within fifteen feet of the entrance to each room lawfully used for sleeping purposes. City of Wheat Ridge E -Res. Electrical Service PERMIT - 202001393 PERMIT NO: 202001393 ISSUED: 07/24/2020 JOB ADDRESS: 4050 Benton St EXPIRES: 07/24/2021 JOB DESCRIPTION: Electrical change, 125 AMPS outdoor panel. 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, po plans 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 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. 4. No work of any 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 or gra i g of a permit shall not be construed to be a permit for, or an approval of, an violation of any provision of any de or ordinance or regulation 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 nf Wheot Ridqe up ".23 1�8�Q�U00� 97/?4/2O2O O9:1O CD8D AMOUNT 9PSP 4O5O Bentnn Si: 156.35 PAYMENT RECEIVED AMOUNT PP / 0246 156.35 AUK CUE; 7857268Y 156.35 T0TAL -------------------- Dina Kemp From: no-reply@ci.wheatridge.co.us Sent: Thursday, July 23, 2020 3:25 PM To: CommDev Permits Subject: Online Form Submittal: Electrical Service Change/Upgrade Permit Application Categories: Dina Electrical Service Change/Upgrade Permit Application This application is exclusively for RESIDENTIAL ELECTRICAL SERVICE CHANGE OR UPGRADE (200 amps or less). YOU MUST ATTACH A VALID CREDIT CARD AUTHORIZATION FORM IN ORDER FOR THE PERMIT TO BE PROCESSED. Your Permit will be emailed to the email address provided below once it is processed. THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN WORK UNTIL PERMIT HAS BEEN ISSUED. Is this application for Yes electrical service change or upgrade - 200 amps or less? PROPERTY INFORMATION Property Address Property Owner Name Property Owner Phone Number (enter WITH dashes, eg 303-123-4567) Attach City of Wheat Ridge Electronic Payment Form - **DO NOT ATTACH A PICTURE OF A CREDIT CARD** 4050 Benton Street Jaclyn Pickard 920-287-9519 WR permit cc.pdf CONTRACTOR INFORMATION Contractor Business Sin Jac Electric Inc Name Contractor's License 018091 Number (This is a 5 or 6 digit number for the City of Wheat Ridge) Contractor Phone 303-424-3898 Number (enter WITH dashes, eg 303-123-4567) Contractor Email Address frank@mysinjac.com Retype Contractor Email frank@mysinjac.com Address DESCRIPTION OF WORK Is this an electrical Change service upgrade or change? Number of Amps 125 Location of house - outside upgrade/change (garage, house, etc) Provide additional details, Upgrading to 125 amp outdoor panel, existing indoor panel if needed. becoming junction box Project Value (contract 3000.00 value or cost of ALL materials and labor) 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 work may not begin on this property until a permit has been issued and posted on the property. Yes Yes 2 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. Person Applying for Frank Wolf Permit Email not displaying correctly? View it in your browser. . City of Wheat Ridge Residential Roofing PERMIT - 201701896 PERMIT NO: 201701896 ISSUED: 06/11/2017 JOB ADDRESS: 4050 Benton ST EXPIRES: 06/11/2018 JOB DESCRIPTION: Residential reroof: Reshingle Architectural shingle, 13 squares *** CONTACTS *** OWNER (720)624-9218 PICKARD JACLYN SUB (720)838-8341 Clinton D. Camp 140192 Talon Restoration *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2412 / LAKESIDE, STEWART GARDENS, OLI BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 3,341.00 FEES Total Valuation 0.00 Use Tax 70.16 Permit Fee 109.20 ** TOTAL ** 179.36 *** 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) requires an approved inspection prior to installation of ANY roof coverings and is require on the entire roof when spaced or board sheathing with ANY gap exceeding k/2 -inch exists. 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 manufacturera€T"s 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&#39;s 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. fr. City of Wheat Ridge Residential Roofing PERMIT - 201701896 ts' PERMIT NO: 201701896 ISSUED: 06/11/2017 JOB ADDRESS: 4050 Benton ST EXPIRES: 06/11/2018 JOB DESCRIPTION: Residential reroof: Reshingle Architectural shingle, 13 squares 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 thgYI am le ally authorized to include all entities named within this document as parties to the work to be per and that all work to be p of disclosed in this document andor its' accompanying approved plans and specifications. Signature of OWN19R CON—TkACTOR (Circle one) Date I , 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 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. 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 apgov I of, any violation of any provision of any applicable code or any ordinance or regulation of this jurisdiction. Approval of work is sub ct to field i,ction. Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Inspection time requests will be accepted by email only. Please email requests to insptimerequest@ci.wheatridge.co.us between 7:30am and 8:00am, the morning of the inspection. Please put the address of the inspection in the subject line. 1211,411 t=ales ,Ave 111111 COs Centennial, i tl 140111 Tel %01 still tit m) t"tas sswwa_TalonRl_rom CLIENT/ CUSTOMER INFORMATION At(t(tt'`r4..L`�r1 City, s(:llf', Zip \.i,_14" r It Is understood that Talon Restoratlon and property owners) are entering Into an agreement that authorizes Talon Restoration to represent owners) and pursue insurance carrier to recover property damages storm related or otherwise- Talon Restoration represents and wanants all work will be completed to approved Insurance company specifications and to local city, county and state codas. Owners) is financially rrsponsibie for labor and materials for code Items not covered by ordinance and law endorsements on policy unless otherwise stated in additional provisions below on this contract. Any upgrades In materials or accessories will be addressed in the additional provisions section of the contract and will require owners) Intlals for approved increase In price if applicable. Agreed upon price wall b"omc the final contract price and Talon Restoration will receive all insurance proceeds for work completed by Talon Restoration. O—er(s) further understand and agree to pay any supplements approved by insurance company arrising during construction or not initially known or covered by insurance company at Intitial Inspection. Owner(s) agree to pay policy deductible per Part 1 Article 4 of title pursuant to section 6-22-105 and warrants Talon Restoration has not offered to pay, waive, or rebate any portion of the deductible applicable to claim. Any insurance proceeds authorised for work not completed by Talon Restoration will be retained by owner(s). If insurance company denies cove ge for any reason, this contract will terminate and neither Talon Restoration nor owner(s) will be obligated to one another. Initials Additional Provisions: Remove 1 layer roof material 7/16" OSB (If required by code) ynderlayment 151b Felt over 7/12 301b leak Barrier (if required by code) )Sable/Eave Drip edge metal Jillew plumbing jacks as required Mew roof vents as required Re -flash wall/ chimney transitions Colortt`k,uuc �jsiu cJ Yaileys closed— open Clean out gutterseplace gutters Magnetic sweep of alis/metal debris Femove all debris from site u11 and clear permit with city ear workmanship warranty Owner and/or agent represents and warrants that any defect or weakness in the promises, structure, sub -structure, superstructure or points of attachment that might affect performance by contractor has been specifically and fully disclosed to contractor. Talon Restoration only guarantees work provided by it. Any pre-existing defects or other condition discovered by Talon Restoration in the course of performing its work, which may affect the performance of Talon Restoration, will be promptly disclosed to Owner and/or agent with repair recommendations and estimate of additional costs. As with any construction work, it is impossible to estimate everything that may be damaged, especially in areas we cannot see before beginning work. If anywhere along our progress unforeseen work needs to be done, we will communicate up front and wait for your approval before continuing work. Payment Schedule"The initial payment will be due upon material delivery and the final payment will be due upon Completion of construction. Talon Restoration will require payment of the ACV amount prior to start of construction. Any payments received from the customer before materials have been delivered will be in held in trust. INITIAL PAYMENT 54001h.9 c �' d,c.� �<lilxnjApprox Start Date: d FINAL PAYMENT S,2 CS • 2 Completion Date: TOTAL PROJECT PRICE Q Insurance Company ir��� _1 Claim# D� S -9 0 Cl Mortgage CompanyjaL,}ti1 l►ht,j�l Loan 4 L4V_-j9' Owner hereb 3uthorrzes Talon Restoration to speak with mortgage company pertaining to clam processing only. < It thas line is not signed, authorization is not accepted. ACCEPTANCE Of PRCWtgAt ve speohcations and condauons are satisfactory and hereby accepted Owner Signature}( Date:T_� Talon Restoration: Xg��� Date: f CERTIFICATE OF LIABILITY INSURANCE D6/(12/201�) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT The Business Protection Team NAME: Colorado Insurance Sales and Services, Inc. 7901 Southpark Plaza INE., Ext): (720) 306-6926 AC No: (720)293-2670 A E-MAIL ADDRESS: thebusinessprotectionteam.com INSURERS AFFORDING COVERAGE NAIC # Suite 110 INSURERA:Cincinnati Specialty Underwriters 13037 Littleton CO 80120 INSURED INSURER B Artisan & Truckers Casualty Co. 10194 INSURERC:Pinnacol Assurance 41190 Talon Financial Corp, INSURER D: DBA: Talon Restoration 12354 E Caley Ave #105 INSURER E: INSURER F: Centennial CO 80111 COVERAGES CERTIFICATE NUMBER:17-18 GL/BA/WC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL J= SUER WVD POLICY NUMBER EFF MMIDDY/YYYY MMIDDY EXP LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR - EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 CSU0099326 6/3/2017 6/3/2018 PERSONAL& ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑ PROLOC 2,000,000JC $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 500,000 BODILY INJURY (Per person) $ B ANY AUTO ALL OWNEDR SCHEDULED AUTOS AUTOS 03450306-2 1/9/2017 1/9/2018 BODILY INJURY Per accident) $ ( ) NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB Ld OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N I PER OTH- STATUTE S ER E.L. EACH ACCIDENT $ 1,000,000 C ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4179770 1/3/2017 1/3/2018 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) l.tK I WIL A I t I'1ULL)tK (:AN(:LLLA I IUN City of Wheat Ridge 7500 W. 29th Ave. Wheat Ridge, CO 80033 ACORD 25 (2014/01) NS025 ren14ni � SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Allison M. Peoples, CIC, CISR © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Antoinette Kulic From: Sent: To: Subject: -7, b �,-A C) 1 '�14 no-reply@ci.wheatridge.co.us Thursday, June 8, 2017 9:52 AM Permits CommDev Online Form Submittal: Residential Roofing Permit Application 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. 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. Permits are currently being processed within 24-48 hours, subject to change based on volume. For all other requests: Homeowners wishing to obtain a roofing permit must apply for the permit in person at City Hall. Existing permits that require amendments (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-f6cluests. PROPERTY INFORMATION Property Address Property Owner Name Property Owner Phone Number Property Owner Email Address Do you have a signed contract to reroof this property? It will need to be provided at the time of permit pick-up. 4050 Benton Street Jaclyn Pickard (920) 287-9519 jaclynpickard@gmail.com Yes CONTRACTOR INFORMATION Contractor Name Talon Restoration Contractor's License 140192 Number (for the City of Wheat Ridge) Contractor Phone 3038088660 Number Contractor Email Address info@talonre.com (permit pick-up instructions will be sent to this email) DESCRIPTION OF WORK Is this application for a new permit for a residential roof? Are you re -decking the roof? Description of Roofing Material How many squares of material? Yes No Re -shingle from architectural to architectural 13 Provide additional detail None - Straight forward re -shingle here on the description of work. (Is this for a house or garage? What is the roof pitch? Etc) Project Value (contract $00.00 value or cost of ALL �� r materials and labor) I SIGNATURE OF UNDERSTANDING AND AGREEMENT I assume full Yes 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 Yes application is NOT a 2 asp x • 0 permit. I understand I will be contacted by the City 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. Name of Applicant Marcos del Rio Email not displaying correctly? View it in your browser. wtic at, F i1c, ( 4 Building & Inspection Services Division 7500 W. 29P Ave,, Wheat Ridge, CO 80033 Office 303-235-2855 "' Fax 303-237-8929 Inspection Une 303-234-5933 FOR OFFICE USE ONIX Planipermit # UMMIMEMEMM Building Permit Application P104,66 complete all highfightod areas on both stilt's Of this Form incomplete appfications may not be processed. Property Address: mirty Owner Em, • Y- Mailing Address" (if different than propefty addms�) Address: ArchitectlEngineer E-mail: Phone:--.----- 1r_111 P)` I' ­7 �) Contractors City License #: ll Phone: a1 71 Sub Contractors: Electric Ws VV, R. City License # Other City Licensed Sub City License # Plumbing W, R, City License # Other City Licensed Sub: City License # Mechanicais W, R. City Ucense # Complete all information on BOTH sides of this form 21Qejs1icrjRAgi2orniSofL&wo2rL (Check all that apply) [I NEW COMMERCIAL STRUCTURE [I ELECTRICAL SERVICE UPGRADE M irnount of materials to be used, etc.) 0 , Sq FULF Btu Is Area Squares 7-x Other Project Value (Contract value or the cost of all rnateriais and labor induded in the entire project) 7 6 "1 (.)N SIGNATI:RE OF UNDEICSTANDING AND AGREEWNT I hereby cerfify that the setback disulnecs pniqxaced by this pernift application are accurate and do not vitilale appkable, ordinances. nfles (if regulations of he City of Wheat Ridgc or covenants, easements or restrictions of'record: that all nicasurcments shown and allegations made are accurnie: fhat I have read and apse e to abide by al I conditions printed on lhi% applical ion and that I asminic Cull responsibility for compliance witty appficaible Clity of Wheat Ridge codes and ordinunces lbr %vork under any perinil issued based (in this application; that I am the legal oivncr or have ht\m authorized by the leg-al tniencr of the prolierly to rwrhinn dre described wt art; Inid am alsiv authorized ky the legal ownur of any entity included on this application to lot this application. CIR(Y E (1NE- M1 OR)"ior (A UTHORIZED )?1 ME) tai t"OHIA`ER) (COATRACTOR) -4 tact N A NA, E V t R111E DA"VE; DEPARTMENT USE ONLY ZONING COMMMENTS CK."CUPANCY CLASMMATION Revkeiver SLALCHNG DEPARTMENTCOWMENTS Reviewer- PUBLiC WORKS COMMENTS: Reviewer PROOF OF SUBMISSION FORMS time Ckeponment ReceiyewJ Not Rcl.4ed Water Chstrict RrIceiveld Not Reouired =Building Division Valuation: Sanitation District Rec,-Wed Not Required Date: Plan # Permit # �O!io Oq4� (please print): .2L Phone:303 .9-37 -767 Address: City, State, Zip: tW Contraotor: Electrical: Plumbing: Mechanical: City License # City License It City License # te Z # # 0 1,