HomeMy WebLinkAbout4769 Dover Street9
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: 3 0 6,- (h d
Job Address: `) 7 L q b y ve c- S) -
Permit Number: "D 0 1$ o I t,-7 a
r19;
❑ No one available for inspection: Time = 39 6^0PM
Re -Inspection required: Yes(9)
When corrections have been made, call for re -inspection at 303 -234 -
Date: -7 Ads -109 Inspector: -T%
DO NOT REMOVE THIS NOTICE
,, ► 1 r City of Wheat Ridge
Residential Roofing PERMIT - 201801672
PERMIT NO: 201801672 ISSUED: 06/07/2018
JOB ADDRESS: 4769 Dover ST EXPIRES: 06/07/2019
JOB DESCRIPTION: Reroof remove and install IKO Cambridge Asphalt Shingles with 23 squares.
Pitch 4/12.
****Revision add redecking 23 squares*****
*** CONTACTS ***
OWNER (303)280-2271 DIYORIO PAULA L
SUB (720)242-6404 Rex Corly 150303 Masterpiece Roofing & Painting
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2002 / KIPLING, I-70 & CLEARCREEK ARE BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 7,707.88
FEES
Total Valuation 0.00
Use Tax 161.87
Permit Fee 172.60
** TOTAL ** 334.47
*** COMMENTS ***
*** CONDITIONS ***
Midroof & Final Roof inspections for ROOFS 6/12 PITCH & OVER: 3rd party inspection will be
required for both the midroof and final inspections. The 3rd party inspection report AND
THE ORIGINAL PERMIT CARD needs to be dropped off to the Permit Desk at the City of Wheat
Ridge. The report MUST BE SIGNED by the Homeowner.
REGARDING ROOF VENTILATION: Roof ventilation shall comply with IBC Sec. 1203.2 or IRC Sec.
R806. The installation of ridge venting requires the installation or existence of soffit
venting. For calculation purposes, one hat or turtle vent equal to one-half of one square
foot of opening.
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 -roofs may be called in at the same time, one hundred percent of the sheathing must be
complete and 25-75 percent of the mid -roof may be complete. 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 - 201801672
PERMIT NO: 201801672 ISSUED: 06/07/2018
JOB ADDRESS: 4769 Dover ST EXPIRES: 06/07/2019
JOB DESCRIPTION: Reroof remove and install IKO Cambridge Asphalt Shingles with 23 squares.
Pitch 4/12.
****Revision add redecking 23 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 ermit. I further attest that I am le ally authorized to include all entities named within this document as partes to the work to be
performed and that all wgrk to be performed is disclosed in this document and/or its' accompanying approved plans and specifications.
3 o U
Signature of OWNER or CONTRACTOR (Circle one) Date
1, This permit was issued based on the information provided in the permit application and accompanying )fans 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
receivedprior 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.
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 is cc 9, granti f ;apermy it shall not be construed to be a permit for, or an approval of, any violation of any provision of any
appli co t or any 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
Cheat jjd
COMMUNITY DEVELOPMENT
FOR OFFICE USE ONLY I
Date: ! ! }- 1 ( , 1 -
177 -
Add to Permfi # /
i7500Building & Inspection Services Division
W. 291h
2C- 1, `�
Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-237-8929
Inspection Line: 303-234-5933 /;
Email: permitsCcpci.wheatridge.co.us
Building Permit Revision/Amendment Applicati
*** Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed.
Property Address: Ln ,
Owner
Property Owner Email: VA v
Mailing Address: (if different than property address)
Address:
City, State, Zip:
Contact Pe
Contractor.
Is
Phone:
Contractors City License #:%C� Phone:
Please Note: Additional valuation must include all general and subcontracted work to be performed
related to the revisions and/or amendments declared in the description of work and which were not
included in the original permit valuation.
If revisions or amendments increase the original valuation, additional fees will be due at the time of
approval. Depending on the scope of work, additional plan review fees may be due upon approval
($60.00 an hour — 2 hour minimum).
aa� t
Description of revised/amended workkc�cc�, u A--,, uctt
-
Sq. FULF � Btu's
Amps
Squares
Gallons
Other
Additional Project Value: (Must include all general and subcontracted work to be performed related to revisions/amendments described above)
$ 5NN\&--. 11-nli5�b.r-
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 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. (OWN ) (CONTRACTOR) or (AUTHORIZED REPRESENTAT E) of (OWNER) (CONTRACTOR)
PRINT NAME: \'� SIGNATURE: / 1 DATF,:n I k \ 1 K/
DEPARTMENT USE ONLY
ZONING COMMMENTS: OCCUPANCY CLASSIFICATION:
Reviewer
BUILDING DEPARTMENT COMMENTS:3
Reviewer:
PUBLIC WORKS COMMENTS:
Reviewer
PROOF OF SUBMISSION FORMS
Fire Department ❑ Received ❑ Not Required
Water District ❑ Received ❑ Not Required
Sanitation District ❑ Received ❑ Not Required
Building Division Valuation: $
9
I* � A i CITY OF WHEAT RIDGE
Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTIC )) rr
3 o o � hCCL
D nc�
Inspection Type: 4, - �l'1
Job Address: L/ 7& 17 No m e r- S 4 -
Permit Number: "d' O) IF 0 11. -7 �
❑ No one available for inspection: Time 1 =) 3 AMM
Re -Inspection required: Ye No
When corrections have been made, call for re -inspection at 303-234-5933
Date: -:;'jlq/19 Inspector: T.�
DO NOT REMOVE THIS NOTICE
i CITY OF WHEAT RIDGE
_:�9�Building InspectionlbiVision
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: 3 ° b - /Yl d'
Job Address: �—) -7G q1c7 o ve r S- '
Permit Number: -3 o 1'B D / 49 -7.a
41
O wo C 3'C W (9 11 Si
❑.No one available for inspection: Time 'd =33 MUM
Re -Inspection required: es No
When corrections have been made, call for re -inspection at 303-234-5933
Date: ZI 3 bg Inspector: T�>
DO NOT REMOVE THIS NOTICE
. A jc /fA,
_7
City of Wheat Ridge
Residential Roofing PERMIT - 201801672
PERMIT NO: 201801672 ISSUED: 06/07/2018
JOB ADDRESS: 4769 Dover ST EXPIRES: 06/07/2019
JOB DESCRIPTION: Reroof remove and install IKO Cambridge Asphalt Shingles with 23 squares.
Pitch 4/12.
*** CONTACTS ***
OWNER (303)280-2271 DIYORIO PAULA L
SUB (720)242-6404 Rex Corly 150303 Masterpiece Roofing & Painting
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2002 / KIPLING, I-70 & CLEARCREEK ARE BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 5,911.00
FEES
Total Valuation 0.00
Use Tax 124.13
Permit Fee 140.90
** TOTAL ** 265.03
*** COMMENTS ***
*** CONDITIONS ***
Midroof & Final Roof inspections for ROOFS 6/12 PITCH & OVER: 3rd party inspection will be
required for both the midroof and final inspections. The 3rd party inspection report AND
THE ORIGINAL PERMIT CARD needs to be dropped off to the Permit Desk at the City of Wheat
Ridge. The report MUST BE SIGNED by the Homeowner.
REGARDING ROOF VENTILATION: Roof ventilation shall comply with IBC Sec. 1203.2 or IRC Sec.
R806. The installation of ridge venting requires the installation or existence of soffit
venting. For calculation purposes, one hat or turtle vent equal to one-half of one square
foot of opening.
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 -roofs may be called in at the same time, one hundred percent of the sheathing must be
complete and 25-75 percent of the mid -roof may be complete. 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.
A City of Wheat Ridge
v
Residential Roofing PERMIT - 201801672
PERMIT NO: 201801672 ISSUED: 06/07/2018
JOB ADDRESS: 4769 Dover ST EXPIRES: 06/07/2019
JOB DESCRIPTION: Reroof remove and install IKO Cambridge Asphalt Shingles with 23 squares.
Pitch 4/12.
I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications;
applica le 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 partes to the work to be
perorme apd that all work to be performed is disclosed ith,sdoc
ument 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 )Tans 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.
1 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
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.
Signat�rr o�C �e'Bul'lri(hv7tf c aI� Date
REQUESTS MUST E MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
enia Reimer
7a/ 8ait�-z
From: no-reply@ci.wheatridge.co.us
Sent: Wednesday, June 6, 2018 1:46 PM
To: CommDev Permits
Subject: Online Form Submittal: Residential Roofing Permit Application
Categories: Gina
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 and due to the volume of requests, time to process
varies and is subject to change. 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.
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 I l
residential roof? W--- \� / k / S 1FP l
How many dwelling units Single Family Home
are on the property?
PROPERTY INFORMATION
Property Address
Property Owner Name
4769 Dover Street
Paula Diyorio
1�045. ids EXplRss
Property Owner Phone 303-280-2271
Number (enter WITH
dashes, eg 303-123-4567)
a�.
Property Owner Email
Address
Do you have a signed
contract to reroof this
property?
Applications cannot be
submitted without an
executed contract
attached below.
Attach Copy of Executed
Contract
Field not completed.
Yes
Diyorio.Contract.Auth.Measure.pdf
CONTRACTOR INFORMATION
Contractor Business Masterpiece Roofing
Name
Contractor's License 150303
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 Address
(Primary address of your
business)
720-242-6404
7700 E Iliff Ave, Ste D
Contractor Email Address pamela@masterpieceroofing.com
Retype Contractor Email pamela@masterpieceroofing.com
Address
DESCRIPTION OF WORK
TOTAL SQUARES of 23
the entire scope of work: �.'�—
Project Value (contract 5750'
value or cost of ALL
materials and labor) ('
Are you re -decking theNo
roof?
Is the permit for a flat
roof, pitched roof, or
Pitched roof (2:12 pitch or greater)
N
both? (check all that
apply)
What is the specific pitch., ,.a 4:12
of the PITCHED roof? `- C —
How many squares are
part of the PITCHED
roof?
Describe the roofing
materials for the
PITCHED roof:
23
L-
Iko Cambridge
Type of material for the Asphalt
PITCHED roof:
Provide any additional ReRoofing 23 squares with Iko Cambridge 1 layer on a 4/12
detail here on the pitch
description of work. (Is
this for a house or
garage? Etc)
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
3
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 Rex Corley
Permit
Email not displaying correctly? View it in your browser.
I FOR OFFICE USE O LF I
Building er it Application
Property Add
pry (girls print):
Prope n t
Malting r (if different than property address)
Aderss:
(amity, State, Zip:
Complete let all information on BOTH slides of this fare
Sq. FULF Btu's Gallons
Amps Squares Other
i CITY OF WHEAT RIDGE
]�� Building Inspection Division
(303) 234 -5933 Inspection line
( 235 -2855 Office • (303) 237 -8929 Fax
I NSPECTION NOTICE
f
Inspection Type: OF
Job Address: q 7 (,gi DcV Eg <J"
Permit Number: l6 1
i
l
❑ No one available for inspection: Time AM /PM
Re- Inspection required: Yes Ko
*When corrections have been made, call f rro I re- nspe }coon at 303 - 2345933
Date: IL I — 1( Inspector; f
DO NOT REMOV THIS NOTICE
B
♦ 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: P"
Job Address: 7M D/k) - �-
Permit Number: fP 7z i
V:
f
(
❑ No one available for inspection: Time ,'!_� A M
,
Re- Inspection required: es No
"When corrections have been made, call for re- inspection at 3a3-234-5933
Date: g � -fir) Inspector:
DO NOT REMOVE THIS NOTICE
4.
" ' City of Wheat Ridge
r40 00 r-
Residential Roofing PERMIT - 102129
PERMIT NO: 102129 ISSUED: 09/08/2010
JOB ADDRESS: 4769 DOVER ST EXPIRES: 09/08/2011
DESCRIPTION: Reroof 20.66 sqs with GAF /ELK Barkwood 30 yr shingles
* ** CONTACTS * **
owner 303/280 -2271 Paula Digorio
sub 303/727 -1110 Michael O'Donnell 02 -2175 A -1 Roofing
** PARCEL INFO
**
ZONE CODE:
UA
USE:
UA
SUBDIVISION:
0215
BLOCK /LOT #:
0/
** FEE SUMMARY ** ESTIMATED PROJECT VALUATION: 9,383.00
FEES ROM
Permit Fee 204.30 Total Valuation .00
Use Tax 168.89
** TOTAL ** 373.19
Conditions:
6 nails per shingle is required. Ice dam membrane is required from eave edge to
2' inside exterior walls. Board sheathing with any gap greater than 1/2"
requires panel sheathing overlay on entire roof. Sheathing inspection is
required prior to covering. Midroof inspection is not required on permits
purchased after 4/18/10. Contractor shall provide ladder for inspections.
Scheduled inspections that cannot be performed due to inclement weather must be
cancelled prior to 8:30 a.m. on the day of inspection or a re- inspection fee
will be assessed.
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 the Wheat Ridge Building Code (I.B.C) and all other
applic! e Wheat Ride Ordinances, for work under this pe-�t. Plans subject to field inspection.
Signature of contractor) other ' acts
1. This permit was issue // d in 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 r a subject to field inspections.
INSPECTION REQUEST LINE: (303)234 -5933 BUILDING OFFICE: (303)235 -2855
REQUESTS MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
Nw 41
_ V City of
Date:
�coMUAT O
Permit #:
Building Division
7500 W. 29 Ave., Wheat Ridge, CO 80033
Office: 303 - 235 - 2855 " Fax: 303 - 237 -8929
Inspection Line: 303- 234 -5933
Facsimile Building Permit Application
Property Address: y'69 ®O ✓C/� gT
Property Owner (please print): J 11MAnt �' Phone: 31�2eD' ,,22 7
Mailing Address: (if different than property address)
Address: 117 719 terr -CT
Contractor: pt-1 L ►? t�x ^tz �QG
Contractor License #: Z Z 1 S Phone: 30 3 -7 Z? -) P 0
Sub Contractors:
Company Name: License #• Expiration Date: Trade /Profession: Approval:
Use of Space (description):
Description of work: -�- ruction Value: S 1 383
(rgFCLIL Plan Review (due at Sme ofsubmiHaf); s
3o Y rw �l 6t
Sq. Ft.fL.Ft added: Squares eV D• BTU's Gallons Amps
OWNEWCONTRACTOR 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 the Wheat Ridge Building Code (I.B.C) and all other applicable Wheat Ridge Ordinances, for work
under this permit Plans subject to field inspection.
CIRLCEONE:.(OWNER) � (CONTRACTOR) or ERSONALREPRES TATIVE f(OWNER) (CONTRATOR) 41P PRINT NAME: -�t !(c'u �- T- SIGNATURE: Date:
DEPARTMENT USE ONLY
ZONING COMMENTS:. - - -
2bnIng:
.Reviewer.
PUBLIC WORKS COMMENTS:
.Reviewer.',
OCCUPANCY:
FIRE- DEPARTMENr.: 17 approved wt comments 0 disapproved 0 no review required I Bldg Valuation: $
Credit Card Payment: Use credit card listed on file. Date: