HomeMy WebLinkAbout6385 W 47th Placeklev��tq
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1,A VI.J.,,OPMENT
PlanlPermit # f)
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Address
City, State, Zip�_
4�O*Otnqineer E4�*� "04L-
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A44, 6
Sub Contrzac
Electrical:
W.R. City License 9'
Plumbing:
W.R. City License #
Mechanical:
AL& -MtvJ,kPo--,P—A-L
Other City Licensed Sub:
City License #
Complete all information on BOTH sides of this form
Project" luet (Contract value or the cost of all materials and labor included in the entire project)
OWNER 'ON I R.XCTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT
I hereby certit� uh, setback distances proposed by this permit application are accurate and do not violate applicable ordinances, roles or
regulations of'ihe C tv of Wheat Ridge or covenants, easements or restrictions of record; that all measurements shown and allegations made are
accurate, that, have rel,d and agree to abide by all conditions printed on this application and that I assurne fall responsibility tear compliance
with applicable Cit of Wheat laid codes and ordinances for work under any pennit issued based ort this application, that I am the legal owner
or have beer au hori/ekdl ', dw legal owner of the property to perfin the described work and at also authorized by the legal owner of any
entity included on !Hs application to list-ftT rt this application.
(4t!TllORIZEDREPRESE <
, E) qJ'(OWNER) (CONTRACTOR)
CIRCLE ATE (Off 'VE10 (CON Z)
ERLN NAME/, 44f - DATE: �- �
SIG N ATU RE -,, 7
Building Division Valuation: $_