HomeMy WebLinkAbout10050.5 W. 29th Avenue0
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Date:
Plan #
Permit #
i #i (please print): lnlqa��- Phone:
Address:
City, State, Zip
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Electrical: Plumbing: Mechanical:
City License # City License # City License #
(Fully describe work to be performed - Attach additional sheet If necessary)
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O)NINEWCONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT
I hereby certify that the setback distance-, 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 arn 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,