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Home My WebLink About6670 W. 44th PlaceCity of Wheat Ridge Community Development Department Memorandum TO: Accounting Department FROM: Kim Cook, Building Division SUBJECT: Refund for Permit DATE: November 9, 2017 Reason: Permit submitted incorrectly, this is for two buildings which should have been pulled on two different permits. Permit #201708697, for 6670 W. 441h Place needs to be closed. Please refund: Contractors License$ (acct 01-510-00-513) 80% permit fee: $ 602.96 (acct 01-510-00-516) 0% plan review $ (acct 01-550-05-551) 100 % use tax: $ 1113.00 (acct 01-500-02-505) Total: $ 1715.96 TO: Exterior Guru 5680 W. 29th Avenue Wheat Ridge, CO 80214 Thank You! Permit Technician ro cit of CV60i�bgo ��3jo �WheatiCI VI/ � I MMLINITY DEVELOPMENT City of Wheat Ridge Municipal Building 7500 W. 29`h Ave. Wheat Ridge, CO 80033-8001 P: 303.235.2855 F: 303.237.8929 Refund Application Complete this application in its entirety, attach all copies of permits, permit cards (if issued) and receipts that were received at the time of permit issuance. Requests for more than 80 percent of the amount paid will not be approved without prior approval from the Building Official. The refund application must be received by the Wheat Ridge Building Division no later than 180 days after permit issuance. Applications received after 180 days of permit issuance will not be approved. You can mail or hand -deliver all required documents to: City of Wheat Ridge, Attn: Building Division, 7500 W. 29th Ave., Wheat Ridge, CO 80033. Company Name/Name (to whom check should be made out to): Address: City:A�Lz t State: 4� Zip: Phone:_'3 ��5- /�y�ax: Email:i-v Permit #e (, O ?0 e, Permit Address: e:6ZI AS // 414 f �� Reason for request: p,2 23p % /e %ice -- IA e- e� A 0? 2 P-1 tN , <:;�' Printed Name: n.4 / U For office use only Signature: Date: J This request has been: A proved Denied Refund Amount: $ Approved by: 1, \, Date: OM ))I www.ci.wh eatridge.com s INSPECTION RECORD Inspection online form: http://www.cl.wheatridge.co.us/inspection Cancellations must be submitted via the online form before 8 a.m. the day of the inspection Inspections will not be performed unless this card is posted on the project site Request an inspection before MIDNIGHT (11:59 PM) to receive an inspection the following business day PERMIT: g� %ADDRESS: OB CODE: tr D X7 11A Foundation Inspections Date Inspector Initials Comments 102 Caissons / Piers 103 Footing / P.E. Letter 104 Foundation Setback Cert. 105 Stem Walls 106 Foundation wall Insulation Do Not Pour Concrete Prior To Approval Of The Above Inspections Underground / Slab Inspections Date Inspector Initials Comments 201 Electrical / Cable/ Conduit 202 Sewer Underground Int. 203 Sewer Underground Ext. 204 Plumbing Underground Int. 205 Plumbing Underground Ext. 206 Water Underground Do Not Cover Underground or Below / In -Slab Work Prior To Approval Of The Above Inspections Rough Inspection Date Inspector Initials Comments 301 Rough Framing 302 Wall Sheathing 303 Roof Sheathing 304 Sheer Inspection 305 Insulation 306 Mid -Roof 307 Metal / Lath / Stucco 308 Rough Electrical Residential 309 Rough Electrical Commercial 310 Electrical Meter Residential 311 Electrical Meter Commercial 312 Temp. Const. Meter 313 Rough Plumbing Residential 314 Rough Plumbing Commercial 315 Shower Pan SEE OVER FOR ADDITIONAL INSPECTIONS PERMIT 0,644 all a Rough Inspection (continued) Date Inspector Initials Comments / 316 Rough Mechanical Residential 317 Rough Mechanical Commercial 318 Boiler / Furnace 319 Hot water tank 320 Drywall screw and Nail 321 Moisture board / shower walls 322 Rough Grading 323 Miscellaneous M Final Inspections Date Inspector Initials Comments 402 Gas Meter Release 403 Final Electrical Residential 404 Final Electrical Commercial 405 Final Mechanical Residential 406 Final Mechanical Commercial 407 Final Plumbing Residential 408 Final Plumbing Commercial 409 Final Roof M 410 Final Window/Door -06117 17, 411 Landscape/Park/Planning* Inspections from these entities shall be requested one week in advance. *For landscaping and parking inspections please call 303-235-2846 **For ROW and drainage inspections please call 303-235-2861 ''**For fire inspections please contact the Fire Protection District for your project. .418 412 Row/Drainage/Public Works** 413 Flood plain Inspection** 414 Fire Insp. / Fire Protection*** 415 Public Works Final** 416 Storm Water Mgmt.** 417 Zoning Final Inspection* Building Final Inspection 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 by the Fire District and Electrical low voltage by the Building Division. 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: 1/02 j<OF Job Address: 6670 W y yt11 G Permit Number: '(Cp/708 7 3 a ❑ No one available for inspectio e Time >l / ! AM/PM Re -Inspection required: Yes No *When corrections have been made, call for re -inspection at 303-234-5933 Date:) / / 7 Inspector: M /nsY DO NOT REMOVE THIS NOTICE 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: M Job Address: 70 W . Permit Number: ZCiI^7C�%2 tA5rE SCh FD(Y e A J wjAc- 1 ►,J sPCT[o (aO- UN' Anr� -TIr_ IT \[r, -KM *No one available for inspection: Time 2 = �Q AIV6M Re -Inspection required: Yes No When corrections have been made, call for re -inspection at 303-234-5933 Date: I Inspector: DO NOT REMOVE THIS NOTICE IV. k� 1 .1 City of Wheat Ridge e Commercial Roofing PERMIT - 201708732 PERMIT NO: 201708732 ISSUED: 10/31/2017 JOB ADDRESS: 6670 W 44th PL EXPIRES: 10/31/2018 JOB DESCRIPTION: Commercial reroof remove and install Tamko asphalt shingles with 115sq pitch=5/12. 6670 to 6690 W 44th Pl whole apartment building. *** CONTACTS *** OWNER (719)963-8690 A & J PROPERTIES TWO LLC SUB (720)262-8060 Joan Mahan 170305 Exterior Guru *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 102 / BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 30,475.00 FEES Total Valuation 0.00 Use Tax 639.98 Permit Fee 511.05 ** TOTAL ** 1,151.03 *** COMMENTS *** *** CONDITIONS *** In order to pass a final inspection on commercial elastomeric or similar type roofing, 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. 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 -roof inspections may be called in at the same time, 100 percent of the sheathing must be complete and 25-75 percent of the midroof may be complete. Asphalt shingles are required to be fastened to the roof deck with a minimum of 6 nails per shingle. 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. ' City of Wheat Ridge ®� Commercial Roofing PERMIT - 201708732 PERMIT NO: 201708732 ISSUED: 10/31/2017 JOB ADDRESS: 6670 W 44th PL EXPIRES: 10/31/2018 JOB DESCRIPTION: Commercial reroof remove and install Tamko asphalt shingles with 115sq pitch=5/12. 6670 to 6690 W 44th Pl whole apartment building. 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 1 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 attest th I am le ally authorized to include all entities named within this document as parties to the work to be performe that all work o be pe ormed is disclosed in this document and/or its' accompanying approved plans and specifications. _s 1- 1-7 Signature of bV�NER or CONTRACTOR (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, 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 maybe subject to a fee equal to one-half of the original ermrt 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 an 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 ranting of a permit shall not be construed to be a permit for, or an approval of, any violation of any provision of any applicable c an ordinanor re lati n 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 �W heat �idge MUNITy DEVELOPMENT Building & Inspection Services Division 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 Inspection Line: 303-234-5933 Email: perm its(@ci.wheatridge.co.us FOR OFFICE USE ONLY Date: Plan/Permit # /10g 73z, Plan Review Fee: j� V l 3 Building Permit Application *** Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. *** Property Address: � 7� — t) '-//-/ � L - Owner (please print): /VV/- J '-�D�c✓1�<S Phone: Property Owner Email: Mailing Address: (if different than property address) Address: S A City, State, Zip: Arch itect/Enaineer: Architect/Engineer E-mail: Phone: Contractor: 'A'� v✓ (��y Contractors City License #: _11Q Phone: Contractor E-mail Address: Sub Contractors: Electrical: W.R. City License # Other City Licensed Sub: City License # Plumbing: W.R. City License # 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 f9COMMERCIAL 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) (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.) ��c n i> s Sq. Ft./LF Zf� Btu's Amps Squares Gallons Other Project Value: (Contract value or the cost of all materials and labor included in the entire project) $ -Ib , Z/ 7- 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 1 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. I, the applicant for this building permit application, warrant the truthfulness of the information provided on the application. CIRCLE ONE. (OWNER) (COOR) or THORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR) Signature (first and last name): DATE: ZONING COMMMENTS: Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: DEPARTMENT USE ONLY OCCUPANCY CLASSIFICATION: Building Division Valuation: $ ® City of Wheat Ridge Commercial Roofing PERMIT - 201708697 PERMIT NO: 201708697 ISSUED: 10/30/2017 JOB ADDRESS: 6670 W 44th PL EXPIRES: 10/30/2018 JOB DESCRIPTION: Commercial Re -roof remove and install TAMKO ashalt shingles with 200 sq Pitch=5/12.. *** CONTACTS *** OWNER (719)963-8690 A & J PROPERTIES TWO LLC SUB (720)262-8060 Joan Mahan 170305 Exterior Guru *** PARCEL INFO *** ZONE CODE: UA / Unassigned SUBDIVISION CODE: 102 / USE: UA / Unassigned BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 53,000.00 FEES Total Valuation 0.00 Use Tax 1,113.00 Permit Fee 753.70 ** TOTAL ** 1,866.70 *** COMMENTS *** *** CONDITIONS *** In order to pass a final inspection on commercial elastomeric or similar type roofing, 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. 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 -roof inspections may be called in at the same time, 100 percent of the sheathing must be complete and 25-75 percent of the midroof may be complete. Asphalt shingles are required to be fastened to the roof deck with a minimum of 6 nails per shingle. 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. PERMIT NO: JOB ADDRESS: JOB DESCRIPTION City of Wheat Ridge Commercial Roofing PERMIT - 201708697 201708697 6670 W 44th Commercial Pitch=5/12. PL ISSUED: EXPIRES Re -roof remove and install TAMKO ashalt 10/30/2017 10/30/2018 shingles with 200 sq 1, by my signature, do hereby attest that the work to be performed shall comply with all accompanyingapproved plans and specifications. applicable building codes, and all applicable municipal codes, policies and procedures, and that 1 am t e 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 pe and 711 a=toformed is disclosed in this document and/or its' accompanying approved plans and specifications. 1 x310-( Signatur ER or CONTRACTOR (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 original permitfee. 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 Off tial and is not guaranteed. 4' No work of an 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 re uired 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 code or any 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 of W heat -Midge COMMUNITY DEVELOPMENT Building & Inspection Services Division 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 Inspection Line: 303-234-5933 Email: perm its(cDci.wheatridge.co.us FOR OFFICE USE ONLY Date: 7 Plan/Permit # `�/ �6 Plan Review Fee: / / 70 Building Permit Application *** Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. *** Property Address: (o 76) Property Owner (please print): coc e S Phone: Property Owner Email: rvvi� . co w\ Mailing Address: (if different than property address) Address: &(Q70 W Lit'( � k #fie_ _�?' V, City, State, Zip: C'Q) Ak �j C_ Co k6;1 -k IA Arch itect/Engineer: Arch itect/E ng 1 neer E-mail: Phone: Contractor: 4 UTO T Contractors City License #: / %(y Phone: Contractor E-mail Address: Sub Contractors: Electrical: W.R. City License # Other City Licensed Sub: City License # Plumbing: W.R. City License # 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 E—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) (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 —i —+ ^f +„ tie i inoa o+^ N c—w �1 Sq. FULF t tofJDl� .r 6d Amps Btu's Squares Gallons Other Project Value: (Contract value or the cost of all materials and labor included in the entire project) $ -!�3 10�0 Les 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. 1, the applicant for this building permit application, warrant the truthfulness of the information provided on the application. CIRCLE ONE: (OWNER) (CONTRALTO or (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR) SiEnature (first and last name): DATE: P-3 0 — ZONING COMMMENTS: Reviewer BUILDING DEPARTMENT COMMENTS: Reviewer: DEPARTMENT USE ONLY OCCUPANCY CLASSIFICATION: Building Division Valuation: $ 10/30/2017 Your Proposal Your Proposal has been Approved! EXTERIOR GURU 5680 W 29th Avenue • Wheat Ridge, CO 80214 • Phone: 720-262-8060 �--- vrtnwaw: i 10-30-2o17 A 8 J Properties 719-96.}8690 6670 W 44th Ave Wheal Ridge, CO 80003 This contract Includes all materials and labor to complete work par price and scope of the customers insurance claim. All the amps listed in this insurance claim will be completed unless otherwise noted here: Code Description Residen0al Re -Roof Remove 200 squares, hoot and dispose of shlrgles. Instal Tamko Heritage asphalt dimensional Reprove and mplam a11 roof compmenls per insurance scope. Drip edge and metal venllaaon is to match the singles. Instal im and wale -as required If required par re-rmf code, decking shall be installed for $1.87aq. ft and supplement (b0ed) to the insurance company. Total Cost: $53,000.00 Permit All work to be completed per the appropriate City/County re -roof code and per manufacture, specifications. All permit fees am in addition to the contract amount and will be supplemented (Willed) to dre insurance company for .imbursement. Final payment is due upon completion not upon inspection due to the City inspection delays. Insurance Claims: This attached document provides legal information on how the State of Colorado requires E donor Gum to handle insurance claims as well as other information. The owner giants permission for Exterior Gum to speak with their In-mrrm C—iec Al insurance claims ars subject to final agreement with the carrier for Mal costs as they pertain to the scope of work Work is to be completed per scope and price of insurance claim. Al insurance proceeds released to Amer for the scope fisted in this contract am due to Exterior Guru upon completion of work and upon funds received by mstomerfmm meir insurancecompany. Detailed infomation regarding w Insumnce Claim mn be found on the .[lathed Insurance Claim document. Purchaser has the right to rescind this contract and obtain a full refund of any deposit within 72 hours after entering the contract per SB038. warranty - Shingle Template: This attached document is a copy of Exterior Gum's warranty. We offer a Life -Time Labor and Material Re -Roof warranty. This document mil be provided to the home owner once the work Is complete and payment in full has been received. Pardon Our Dust This attached document may be shared wtih your neighbors to let them know eidelor work will be taking place st your home and provides them Win a phone number to call If any debris gets on their property. How To preps : This attached document informs the customer how to prepare for the day(s) work will m completed. Paymems for Insurance Claims: Customers AVC check is due at the time of contract and will be deposited into an count to be held to purchase materials fo their project. Ali proceeds from the customers imorence claim in this contract am due to EAerlor Gum. Recoverable depreciation (RCV) Is due upon customer necelpt from their Insurance company. Terms and Conditions: This attached document infoms the custorner of the toms and conditions of be contract Upon signing this contract VWe, acknowledge that UWe have read the attached documents and agree to their terms and conditions. Signature Approved by: 44 A 8 J Properties Data: 10-262017 8:45 AM https://buildertrend.net/LeadsILeadProposalExternal.aspx?IeadlD=c-Ww-MI_Ano&proposalld=xaVM2VvaagU&openPrint=True 1/1 • A t # • please o m lets all highlighted areas on both slides of this form.1noomplots app0ta may n be processed, � * Property Address Prope Owner (ple print): AT P Fo0n Property Owner Email* M ailing Address. if different than property address) Address: it , State, r ,rr hitectt Engi r E-mail: phone: Contractor: � � ' '�' X16 �c� C ontractors Cis Ucanse Phone.. I Contractor E - Address: ,, ,, Sub Contractors-. E lectrical: Plumbing: ; Mechanical„ W.R. City license # WR City License # WR City License # Other City Licensed Sub. Other City Licensed Sub: City License # City License # Complete ill information on BOTH sides of this form City of Wheat Ridge Community Development Department Memorandum TO: Accounting Department FROM: Kim Cook, Building Division SUBJECT: Refund for Permit DATE: November 9, 2017 Reason: Permit submitted incorrectly, this is for two buildings which should have been pulled on two different permits. Permit #201708697, for 6670 W. 441h Place needs to be closed. Please refund: Contractors License$ (acct 01-510-00-513) 80% permit fee: $ 602.96 (acct 01-510-00-516) 0% plan review $ (acct 01-550-05-551) 100 % use tax: $ 1113.00 (acct 01-500-02-505) Total: $ 1715.96 TO: Exterior Guru 5680 W. 29th Avenue Wheat Ridge, CO 80214 Thank You! Permit Technician ro cit of CV60i�bgo ��3jo �WheatiCI VI/ � I MMLINITY DEVELOPMENT City of Wheat Ridge Municipal Building 7500 W. 29`h Ave. Wheat Ridge, CO 80033-8001 P: 303.235.2855 F: 303.237.8929 Refund Application Complete this application in its entirety, attach all copies of permits, permit cards (if issued) and receipts that were received at the time of permit issuance. Requests for more than 80 percent of the amount paid will not be approved without prior approval from the Building Official. The refund application must be received by the Wheat Ridge Building Division no later than 180 days after permit issuance. Applications received after 180 days of permit issuance will not be approved. You can mail or hand -deliver all required documents to: City of Wheat Ridge, Attn: Building Division, 7500 W. 29th Ave., Wheat Ridge, CO 80033. Company Name/Name (to whom check should be made out to): Address: City:A�Lz t State: 4� Zip: Phone:_'3 ��5- /�y�ax: Email:i-v Permit #e (, O ?0 e, Permit Address: e:6ZI AS // 414 f �� Reason for request: p,2 23p % /e %ice -- IA e- e� A 0? 2 P-1 tN , <:;�' Printed Name: n.4 / U For office use only Signature: Date: J This request has been: A proved Denied Refund Amount: $ Approved by: 1, \, Date: OM ))I www.ci.wh eatridge.com s d q a Q r r � � o O El ca Z o 0 0 si CL v Q W „ ro D a z° ♦, W n rn Q 7 4 0 a rn o m N r r � •.i 0 0 u 4 O P4 z :C R.S 00 O d0 �a w od a w0 U � c d d U. C ow O '' 41 v w t0 P4 1 U x l E W m q 4 � v � w w UO � a Mnp N 01 q a Q r r � � o O El O Z o 0 0 si v Q W o 0 v Q a z° A A n rn Q r r � •.i 0 0 u 4 O P4 z o 0 N N Y O �U 0 N d2 m W mN a:) U2 d LL C O r m 3 n N Of O Z Q O CL .. t v a na CL O N r U r V q O E E 3 co m C N O CL J m m m z z z w w w E � � � r r a a a O F F F •'I H H H w a a a u W m m m v 04CII 04 a m w m w m w