HomeMy WebLinkAbout4200 Upham StreetContractor Business denver egress window
Name
Contractor's License 150231
Number (This is a 5 or
6 digit number for the
City of Wheat Ridge)
Contractor Phone
Number (enter WITH
dashes, eg 303-123-
4567)
Contractor Email
Address
Retype Contractor
Email Address
DESCRIPTION OF WORK
Number of EGRESS
windows being
replaced
Location of EGRESS
window(s) being
replaced (for example,
master bedroom,
kitchen, bathroom, etc):
What is the u -value of
the EGRESS
window(s)? City of
Wheat Ridge requires
the u -value to be .30 or
better on windows.
Attach copy of
Engineer stamped
letter showing vertical
cuts detail and u -value
720-626-4221
info@denveregresswindow.com
info@denveregresswindow.com
1
basement
21
Depinto-4220 N. Upham St. -Wheat Ridae-SNTW2790-22319-
SIGNED Ddf
Project Value (contract 3500
value or cost of ALL
materials and labor)
SIGNATURE OF UNDERSTANDING AND AGREEMENT
Yes
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 Yes
may not begin on this
property until a permit
has been issued and
posted on the property.
I certify that I have Yes
been 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 stephen sennett
Pe rm it
Email not displaying correctly? View it in your browser.
From: no-reolvCalci.wheatridae.co.us
To: CommDev Permits
Subject: Online Form Submittal: PERMIT APPLICATION Residential Egress Window
Date: Monday, May 16, 2022 1:34:19 PM
CAUTION:This email originated from outside of the organization. Do not click links or open attachments unless you
recognize the sender and know the content is safe. Report any suspicious activities to the IT Division.
PERMIT APPLICATION Residential Egress Window
This application is exclusively for RESIDENTIAL EGRESS WINDOWS ONLY.
YOU MUST ATTACH A VALID CREDIT CARD AUTHORIZATION FORMAN D
ENGINEER LETTER STAMPED DETAIL SHOWING THE U -VALUE OF THE
WINDOWCUT 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
existing EGRESS
window(s) needing
vertical cuts only?
PROPERTY INFORMATION
Property Address 4220 upham st
Property Owner Name
Property Owner Phone
Number (enter WITH
dashes, eg 303-123-
4567)
Property Owner Email
Address - Do not enter
a contractor email
address
Attach City of Wheat
Ridge Electronic
Payment Form - "DO
NOT ATTACH A
PICTURE OF A
CREDIT CARD"
rick depinto
303-229-2409
Field not completed.
CONTRACTOR INFORMATION
Contractor Business denver egress window
Name
Contractor's License 150231
Number (This is a 5 or
6 digit number for the
City of Wheat Ridge)
Contractor Phone
Number (enter WITH
dashes, eg 303-123-
4567)
Contractor Email
Address
Retype Contractor
Email Address
DESCRIPTION OF WORK
Number of EGRESS
windows being
replaced
Location of EGRESS
window(s) being
replaced (for example,
master bedroom,
kitchen, bathroom, etc):
What is the u -value of
the EGRESS
window(s)? City of
Wheat Ridge requires
the u -value to be .30 or
better on windows.
Attach copy of
Engineer stamped
letter showing vertical
cuts detail and u -value
720-626-4221
info@denveregresswindow.com
info@denveregresswindow.com
2
basement
21
Zachmeier-2-4200 UDam St. -Wheat Ridae-SNTW2789-22318-
SIGNED Ddf
Project Value (contract 7000
value or cost of ALL
materials and labor)
SIGNATURE OF UNDERSTANDING AND AGREEMENT
Yes
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 Yes
may not begin on this
property until a permit
has been issued and
posted on the property.
I certify that I have Yes
been 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 stephen sennett
Pe rm it
Email not displaying correctly? View it in your browser.
From: no-reolvCalci.wheatridae.co.us
To: CommDev Permits
Subject: Online Form Submittal: PERMIT APPLICATION Residential Egress Window
Date: Monday, May 16, 2022 1:18:34 PM
CAUTION:This email originated from outside of the organization. Do not click links or open attachments unless you
recognize the sender and know the content is safe. Report any suspicious activities to the IT Division.
PERMIT APPLICATION Residential Egress Window
This application is exclusively for RESIDENTIAL EGRESS WINDOWS ONLY.
YOU MUST ATTACH A VALID CREDIT CARD AUTHORIZATION FORMAN D
ENGINEER LETTER STAMPED DETAIL SHOWING THE U -VALUE OF THE
WINDOWCUT 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
existing EGRESS
window(s) needing
vertical cuts only?
PROPERTY INFORMATION
Property Address 4200 Upham st
Property Owner Name
Property Owner Phone
Number (enter WITH
dashes, eg 303-123-
4567)
Property Owner Email
Address - Do not enter
a contractor email
address
Attach City of Wheat
Ridge Electronic
Payment Form - "DO
NOT ATTACH A
PICTURE OF A
CREDIT CARD"
becky zachmeier
303-507-0932
Field not completed.
CONTRACTOR INFORMATION
City of Wheat Ridge
Residential Roofing PERMIT - 201703096
PERMIT NO: 201703096 ISSUED: 07/03/2017
JOB ADDRESS: 4200 Upham ST EXPIRES: 07/03/2018
JOB DESCRIPTION: Residential Re-r'oof to install GAF Timberline HD Architectural asphalt
shingles - 19sq.
*** CONTACTS ***
OWNER (720)231-4327 AYLER CRAIG A
SUB (720)201-7933 Tanner Grass 170144 Colorado's Finest Roofing
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT*: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 6,080.00
FEES PAID
Total Valuation 0.00
Use Tax 127.68
Permit Fee 156.75 f_
** TOTAL ** 284.43
*** 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 one half 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 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.
City of Wheat Ridge
Residential Roofing PERMIT - 20170309.6
PERMIT NO: 201703096 ISSUED: 07/03/2017
JOB ADDRESS: 4200 Upham ST EXPIRES: 07/03/2018
JOB DESCRIPTION: Residential Re -roof to install GAF Timberline HD Architectural asphalt
shingles - 19sq.
I, by my� si-nature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications,
applicable uilding 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
perfor 'e,�aid that all work to be -performed is..discfosed in this document and/or its'.acc ompanying approved plans and specifications.
Signature of OWNEW or CONTRACTOR--TC—ircle 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.
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, an violation of any provision of any
applicable 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.
Inspection time requests will be accepted by email only. Please email requests to insptimerequestgei.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.
Dan Schultz 20170306
From: no-reply@ci.wheatridge.co.us
Sent: Wednesday, June 21, 2017 9:51 PM
To: Permits CommDev
Subject: Online Form Submittal: Residential Roofing Permit Application
Categories: Dane
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 5 business days, 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. Revisions to existing permits (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 requests.
THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN
REROOFING UNTIL PERMIT HAS BEEN ISSUED.
Is this application for a Yes
residential roof?
How many dwelling units Single Family Home
are on the property?
PROPERTY INFORMATION
Property Address
Property Owner Name
Property Owner Phone
Number
4200 Upham ST
Craig Ayler
720-231-4327
V/C/, U6f a V K
G
r--
G
7zzJ
Property Owner Email
Field not completed.
Address
Do you have a signed
Yes
contract to reroof this
property?
It will need to be
provided at the time of
permit pick-up.
CONTRACTOR INFORMATION
Contractor Name
Colorado's Finest Roofing
Contractor's License
170144
Number (for the City of
Wheat Ridge)
Contractor Phone
720-201-7933
Number
Contractor Email Address
coloradosfinestroofing@gmail.com
Retype Contractor Email
coloradosfinestroofing@gmail.com
Address
DESCRIPTION OF WORK
Are you re-decking the
No
roof?
Description of Roofing
GAF Timberline HD architectural shingles
Material
Select Type of Material:
Asphalt
If "Other" is selected
Field not completed.
above, describe here:
How many squares of the
19
material selected above?
Does any portion of the
No /
property include a flat
roof?
If yes, how many squares
Field not completed.
on the flat roof?
z
TOTAL SQUARES of all
roofing material for this
project
Provide additional detail
here on the description of
work. (Is this for a house
or garage? What is the
roof pitch? Etc)
Project Value (contract
value or cost of ALL
materials and labor)
19/
Roof, garage, small shed 5/12
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
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 Tanner Grass
Email not displaying correctly? View it in your browser.
3
.
W
This proposal maybe withdrawn by Colorado's Thornton, CO 10673 Eudora a W;
Finest Roofing if not accepted within 30 days from
the proposal date. Phone: 720-201-793
www.coloradosfinestroofing.cor
coloradosfinestroofing@gmail.cor
Name: • `
JobAddress: Proposal Date:
City, State, Zip: Services Provided
ProjectManager:
Phone: :' ,
Cell Phone: _.
Mailing Address: Email::
(If Different) Insurance Company:_
Email Address: Adjustor Information:
Best way to contact: PolicyNumber:
El w Claim Number: > `X!
Tear Off Layer(s) of , : �
Inspect Decking: Deteriorated existing decking
Repair at cost of $ per sheet, Homeowner
will be notified if any damaged wood is found during tear off.
0 Install ice shield on leaves and in valley(s)
❑ Install drip edge
❑ Install underlayment
Ca Recover roof with
❑ year manufacturer
warranty.
❑ Color:
El 6 nail every shingle
fl Install, x F �ridge style
❑ Installpipejacks ❑ Re -flash swamp cooler
• Stepflashsidewalls❑ stepflashchimney l3 stepflashskylight
❑_ Colorado's Finest Roofing will provide'general liability
Insurance up to $2,000,000
Clean up and haul off roofing debris ❑ Clean Gutgutters_.
Magnetic sweep of surrounding area CJ Clean out landscaping
❑ All required permits furnished by Colorado's Finest Roofing
To be reimbursed by Insurance Company
Colorado's Finest Roofing I year warranty on labor
❑ Current Ventilation Recommended
❑ Decline recommendation on ventilation
EIGutters:
Color. Outlet:
❑ Siding:
❑, Extra work
Special Instructions:
* Colorado's Finest Roofing shall hold in
trust any payment received from you until
contractor has delivered roofing materials at
the site or has performed a majority of the
roofing work on your property.
a� irr 4.;
$ amount to be collected at
time of material delivery
Initial total claim amount
as of / /20 This price
is subject to supplements/adjustments.
Roof work to be completed within 30 days of final
:> _ _ insurance approval and mortgage endorsement.
Date of Acceptance
Colorado's Finest Roofing Representative Homeowner's Signature
Property Owner is /is not intending to make payment from the proceeds of a property and
casualty insurance policy. If so, homeowner must read and sign below.
I/we agree to retain Colorado's Finest Roofing (Contractor) to repair/ replace the damaged or entire portion of the property described in this contract contingent
on obtaining my insurance company's approval and payment to have said work completed. It is agreed that the contractor is empowered to contact my insurance
carrier and to meet with their representative in order to negotiate the amount of damage, the cost of the repair or replacement of the damage to the above
property. Upon the insurance carrier agreement with the contractor and the down payment being made, the work will be scheduled and may begin on a first in an(
first out basis.
Checks Shall be made payable to Colorado's Finest Roofing
In the event that the insurance carrier fails to negotiate in a fair and reasonable manner, the contractor shall not be held liable and the agreement will be void.
Insured out of pocket expense will not exceed the insured (purchaser) policy deductible for the work agreed upon between the insurance carrier and the
contractor. The insured also agrees to provide all necessary documentation for the claim (including documentation to facilitate payment from insurance carrier
and/or mortgage holder). The contractor reserves the right to file supplemental claims due to material and/or labor increases due to a storm environment or
adjuster's mistakes errors or omissions.
A 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: /A 1 )) S O /`
Job Address: HZ00 UA -M S7 -
Permit Number: Z 0) i s -30cl C
❑ No one available for inspection: Time 1 AM/PM;
Re -Inspection required: Yes (N9v)
When corrections have been made, call -for re -inspection
at 303-234-5933
�� Date: � Inspector: MQ, r+
DO NOT REMOVE THIS NOTICE
Inspections 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.
INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS JOB G�
FOUNDATION INSPECTIONS
DATE
INSPECTOR
INITIALS
COMMENTS:
Footings /Caissons
Stemwall / (CEG) Concrete
Encased Ground
Reinforcing or Monolithic
Weatherproof /French Drain
Sewer Service Lines
Water Service Lines
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
CONCRETE SLAB FLOOR
Electrical (Underground)
INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE WORKS
SHOULD BE CALLED AT LEAST ONE WEEK PRIOR TO FINAL. INSPECTIONS.__...
Parking & Landscaping
Plumbing (Underground)
` *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
- OF A CERTIFICATE OF OCCUPANCY NOR PERMISSION FOR OCCUPANCY.
Heating (Underground)
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGHS
Sheathing
Lath / Wall tie
Mid -Roof
Electrical Service
Rough Electric
Rough Plumbing
Gas Piping
Rough Mechanical
c omncU rmUK w raweernrvU
Framing
Insulation
Drywall Screw -
FINALS
Electrical
d
.r4�5'o f2'2
Plumbing
Mechanical
Roof
Building Final
Fire Department
R.O.W & Drainage
INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE 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
- OF A CERTIFICATE OF OCCUPANCY NOR PERMISSION FOR OCCUPANCY.
OCCUPANCY NOT PERMITTED UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED
PROTECT THIS CARD FROM THE WEATHER
❑ No one available for inspection: Time r�r
Re- Inspection required: Yes No
When corrections have been made, call for re- inspe,
Date: d� /r' f ✓p Inspecto
DO NOT REMOVE THIS N07
City of Wheat Ridge
- r�
Residential Electric PERMIT - 102503
PERMIT NO: 102503 ISSUED: 11/02/2010
JOB ADDRESS: 4200 UPHAM ST EXPIRES: 11/02/2011
DESCRIPTION: 200 amp service change
* ** CONTACTS * **
owner 720/231 -4327 Craig Ayler
sub 303/330 -2688 Clark Hill 10 -0333 Clark Hill Electric
** PARCEL INFO **
ZONE CODE: UA USE: UA
SUBDIVISION: UA BLOCK /LOT #: 0/
** FEE SUMMARY ** ESTIMATED PROJECT VALUATION: 2,250.00
FEES
Permit Fee 93.35
Total Valuation .00 IbN -052•
Use Tax 40.50
** TOTAL ** 133.85 PA,
Conditions:
Must comply w/ 2006 IRC & 2005 NEC.
Subject to field inspections.
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 that I assume full responsibility for compliance with the Wheat Ridge Building Code (I.B.C) and all other
applicable e Ri4gJ Ordina %ea� fcf - woq ib urger this permit. - Fans subject to field inspection.
Signature of
1. This permit was issued accordance with the provisions set forth in your application and is subject to the laws of the
State of Colorado and to the Zoning Regulations and Building Codes of Wheat Ridge, Colorado or any other applicable
ordinances of the City.
2. This permit shall expire 180 days from the issue date. Requests for an extension must be received prior to expiration
date. An extension may be granted at the discretion of the Building Official.
3. If this permit expires, a new permit may be acquired for a fee of one -half the amount normally required, provided no
changes have been or will be made in the original plans and specifications and any suspension or abandonment has not
exceeded one (1) year. If changes have been or if suspension or abandonment exceeds one (1) year, full fees shall
be paid for a new permit.
4. No work of any manner shall be done that will change the natural flow of water causing a drainage problem.
S. Contractor shall notify the Building Inspector twenty -four (24) hours in advance for all inspections and shall receive
written approval on inspection card before proceeding with successive phases of the job.
6. The issuance of a permit or the approval of drawings and specifications shall not be construed to be a permit for, nor
an approval of, any violation of the provisions of the building codes or any other ordinance, law, rule or regulation.
All plan revWvw.is subject to field inspections.
iN REQUEST LINE: (303)234 -5933 BUILDING OFFICE: (303)235 -2855
MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY
f
City Sri
� � l
g
d1rV iactFktfrai
plan
Building & Inspection Services Division Permit # 2 r �
7500 W. 29" Ave., Wheat Ridge, CO 80033
Office: 303 -235 -2855 ' Fax: 303- 237 -8929
Inspection Line: 303- 234 -5933
Building Permit Application
Property Address
Property owner (please print): � Pho ne_ �y_ �_ L 13z
Mailing Address: (if different than property address)
Address: �z 20 e-)
City, State, zip:
C,onfiractot•: .�m_. ��f � ` �'��,Pr1t t'� .— � _____._ -_
Contractors City License Phone:'
antio »tpactotsa'
Electrical: Plumbing: Mechanical:
City License # City License # City License #
Nscvi �anu�rir
Contract Value: e�
Squares BTU's _ Gallons _ Amps ,�`\ $
� Sq Ft
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 mad 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 1 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.
CIRCLE ONE: (OWNER) ONT(iAC ) er (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR)
0 PRINT NAME: SIGNATURE: 0 DATE: iIl
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EIRE,(pEPRt;77v1ENr- � appl'oyed Wl comments II disapprgved L3- no'Y�utew�rs`qutred ; Bldg Valuation. $