HomeMy WebLinkAbout7350 W. 44th PlaceFOR OFFICET
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Citgo of
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Wh6at1ic
Building & Inspection Services Division
7500 W. 29th Ave.; Wheat Ridge, CO 80033 `
Plan Review Vie:
Office: 3013-235-2855 * Fax; 303-237-8929
Inspection Line: 303-234-5933
Email: errnits ci. i eats d e.c .0
Building er ' it Application
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Mallino do ress: (if different than property address)
Address:
City, State, i ... < 4 'e )- C 0 0 I
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Architect/Engineer phone.
Contractor: L"vi,
Contractors City License Phone:
e
Sub Contractors.-
Electrical:
ontr cars.lectri l: Plumbing: Mechanical:
l:
W.k City License # W.R. City License # W.R2 City License #
Other City Licensed Sub. Other City LicensedSub:
City License # City License
Complete all dfor ation on BOTH sides oft is form
! a a er #! a • M t er � 9M • a
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CERTIFICATE OF COMPLETION
City of Wheat Ridge
7500 W 29th Ave
Wheat Ridge CO 80033
Permit# 110044 Issued: 02/17/11
Stipulations: Interior Remodel
This certificate verifies that the building constructed and/
or the use proposed of the building and /or premises, under
the above permit number and on property described below,
does comply with the Wheat Ridge Building Code and
development standards of the zone district in which it is
located and may be occupied. All other licensing
requirements for the City must be met.
Site Address: 7350 W 44TH PL
Parcel Number: 39- 231 -14 -002
Owner: Eve Park
7350 W. 44th Pl
Wheat Ridge CO 80033
Contractor: James Dudley
Jo -D Enterprises, Inc.
6365 W. 46th Ave
Wheat Ridge, CO 80033
For the Following Purpose: Residential Remodel
Code Editions NO change shall be made in the USE of
6 ICC /2008 NEC this building without prior notice
2006 ICC /2005 NEC and a new Certificate of Completion
2003 ICC /2005 NEC from the City of Wheat Ridge.
Sprinkler Sy„�tem
ng Inspector Zoning Administrator
TE MUST BE POSTED BY FRONT DOOR OF
COMMERCIAL OCCUPANCIES
02/18/11 08:18:11
City of Wheat Ridge
Page 1
bp701 -1s
PERMIT INFORMATION - 110044
a.key
PERMIT INFORMATION:
Permit #: 110044
Address: 7350 W 44TH PL
Permit Type: Residential Remodel
Parcel Cd: 39- 231 -14 -002
Permit Dt: 01/18/2011
OWNER: Eve Park
Expires: 01/18/2012
Address: 7350 W. 44th P1
City /St /Zip: Wheat Ridge CO 80033
LAND PARCEL INFORMATION:
Zone Cd: Unassigned
DU: 1 SetBacks-
Front:
0.0
Funct Use: Unassigned Last Zone Dt:
Left:
0.0
Subdivision: EARTHS, COULEHAN GRA
Annex Dt:
Right:
0.0
Cont Type: Miscellaneous
Lot: Block No: 0
Back:
0.0
Legal:
JOB DESCRIPTION: Windows, doors, tile, plumbing, electrical, insulati
FEES QTY DUE
PAID:
Permit Fee 14,105.00 283.55
283.55
Plan Review Fee .00 184.31
184.31
Total Valuation 14,105.00 .00
.00
Use Tax 14,105.00 253.89
253:89
---- - - - - --
721.75
--- - - - - --
721.75
CONTACTS:
owner Eve Park 7350 W. 44th P1 Wheat Ridge CO
80033 7203410025
go CL2 Jo-0 Enterprises, Inc. James Dudley 6365
W. 46th Ave Wheat Ridge, CO 80033
3034317848
sub CIA O'Brien Electrical Contractors Richard O'Brien
3697 S. Waco St. Aurora, CO 80013
3034631600
sub CIS DOro, Botzum Donn Botzum 6385 W. 5th Place
Lakewood, CO 80226 3032021066
PARCEL INFORMATION:
10 Structure Type RANC
20 Year Built 1947
30 Property Type RESID
PERMIT CONDITIONS:
JZ: Approved per plans and red -line notes
on plans. Must comply with 2006 IRC,
2005 NEC, and all applicable City of Wheat
Ridge Municipal Codes. Subject to
field inspections.
APPROVALS:
REQUIRED INSPECTIONS STATUS:
PERMIT NOTES:
01/18/11 Given to JZ for review.
01/18/11 CREATED FROM APPL# 11 -0013
INSPECTION INFORMATION:
# TYPE CONTR# CALLED
CNCL WHO REQ DT INS DT
STATUS
1 PRI:Plumbing Rough Insp. 06 -0232 01/26/11
no KC 01/28/11 01/28/11
COMPLETE
2 ERI:Electrical Rough IRS 01/28/11
no KC 01/28/11 01/28/11
COMPLETE
3 DWS:Drywall SCrew /nail 01 -9373 02/02/11
no KC 02/03/11 02/03/11
COMPLETE
4 EFI:Electrical Final Ins 06 -0021 02/16/11
no KC 02/17/11 02/17/11
COMPLETE
5 PFI:Plumbing Final Insp 06 -0232 02/16/11
no KC 02/17/11 02/17/11
COMPLETE
6 BFI:BUilding Final Insp 01 -9373 02/16/11
no KC 02/17/11 02/17/11
COMPLETE
02/18/11 08:18:11 City of Wheat Ridge Page 2
bp70l -ls PERMIT INFORMATION - 110044 mmackey
7 MFI:Mechanical Final 02/17/11 no KC 02/17/11 02/17/11 COMPLETE
INSPECTION RECORD
Occupancv/TVpe
INSPECTION LINE: (303) 234 -5933
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.
FOUNDATION INSPECTIONS I NSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS JOB
INSPECTOR
Stemwall / (CEG) Concrete
Encased Ground
Reinforcing or Monolithic
Weatherproof / French Drain
Sewer Service Lines
Water Service Lines
CONCRETE SLAB FLOOR
Electrical (Underground)
Plumbing (Underground)
ROUGHS
Sheathing
1 7 „
Insulation �l
Lath / Wall tie
✓f
Drywall Screw.
Mid -Roof
'k4t�
Electrical Service
Rough Electric
P 2$loI
Rough Plumbing
f ,g N ,
.�
-
Gas Piping
INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE WORKS
SHOULD BE CALLED AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS.
Rough Mechanical
* * 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.
Framing
Electrical X
1 7 „
Insulation �l
Plumbing X
✓f
Drywall Screw.
I I
'k4t�
FINALS
Electrical X
1 7 „
Plumbing X
✓f
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
A
• CITY OF WHEAT RIDGE
Building Inspection Division
(303) 234 -5933 Inspection line
(303) 235 -2855 Office - (303) 237 -8929 Fax
INSPECTION NOTICE
Inspection Type S"47 -, 2 0
Job Address 73,a w Yf'YW Ay
Permit Number fJ�VY
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(303) 234 -5933 Inspection line
(303) 235 -2855 Office'' (303) 237 -8929 Fax
INSPECTION NOTICE
Inspection Type r tAIS
Job Address 755a 6iv. Vy.? ' .°.
Permit Number lle � VI/
❑ No one available for inspection: Time AM/ A
V
Re- Inspection required: Yes
When corrections have been made, call for re- inspection at 303 - 234 -5933
Date: Inspector:
DO NOT REMOVE THIS NOTICE
, (303)234 -5933 Inspection line
(303) 235 -2855 Office `* (303) 237 -8929 Fax
INSPECTION NOTICE
Inspection Type
Job Address _qS`P
Permit Number l ego
k ❑ No one available for inspection: Time <`,� S" AM /M
Re- Inspection required: Yes
When corrections have been made, call for r - inspection at 303- 234 -5933
Date: /A� Inspector:
DO NOT REMOVE THIS NOTICE
City of Wheat Ridge
Residential Remodel PERMIT - 110044
PERMIT NO: 110044 ISSUED: 01/18/2011
JOB ADDRESS: 7350 W 44TH PL EXPIRES: 01/18/2012
DESCRIPTION: Windows, doors, tile, plumbing, electrical, insulati
* **
CONTACTS * **
ZONE CODE:
UA
owner
720/341 -0025
Eve Park
0801
BLOCK /LOT #:
0/
gc
303/431 -7848
James Dudley
01
-9373
Jo -D Enterprises, Inc.
sub
303/463 -1800
Richard O'Brien
06
-0021
O'Brien Electrical Contractors
sub
303/202 -1066
Donn Botzum
06
-0232
Donn Botzum
** PARCEL INFO
**
ZONE CODE:
UA
USE:
UA
SUBDIVISION:
0801
BLOCK /LOT #:
0/
** FEE SUMMARY ** ESTIMATED PR T A �'�14,105.00
FEES
Permit Fee 283.55 "DIIC'1.$JL�
Plan Review Fee 184.31 + -
Total Valuation , 00 � . (��
Use Tax 253.89 t
** TOTAL ** 721.75
Conditions:
JZ: Approved per plans and red -line notes on plans. Must comply with 2006 IRC,
2005 NEC, and all applicable City of Wheat Ridge Municipal Codes. Subject to
field inspections.
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 permit. I further attest that I am legally authorized to include all
entities named within this d�ment as parties to the work to be performed and that all work to be performed is disclosed in
this�document.,.and /or 't'3' a- companying approved plans and specifications.
Signature of OWNE'7n' M7 Ci cle 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.
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 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, any violation of
any provision of any applicable code or any ordinance or regulation of this jurisdiction. Approval of work is subject
to field inspecti n.
Signature of uilding Offical Date
''INSPECT N EQUEST LINE: (303)234 -5933 BUILDING OFFICE: (303)235 -2855
REQUES S MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
Clty of 7
h6at R dge Date: e� ��
COM 1s� .
MUNiTy DEVELOPMENT Plan #
Building & Inspection Services Division Permit # i'
7500 W. 29 Ave., Wheat Ridge, CO 80033 C C
Office: 303 -235 -2855 * Fax: 303 - 237 -8929
Inspection Line: 303- 234 -5933
Building Permit Application
Property Addessti / �S�O ��
Property Owner (please print): v9 Phone:
Mailing Address: (if different than property address)
Address:
City, State, Zip:
Con #ractor: Eo
Contractors City License #: Phone: I - 7
StitiyContractors'
Ele !;T/pc- Plumbing: 1jZ,7Lza M 7 L, Mechanical:
City License # City License # City License #
bescrtn #ton�ftiuorks+ �,�, da,:�s- ; DTrvtO - j /
t ,/ l I A l Y �' M—C� — may �� '� Contract Value:
Review Fee (due at time of submittal):
Squares BTU's Gallons Amps Sq Ft. _
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 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) (CONTRACTOR) or (AUTHORIZED REPRESENTATIVE) of (O ER) (CONTRACTOR)
PRINT NAME / f44� ; - )44 , dl IGNATORE DATE : - I -/ cV"
,..,� %, ri<,.�:.r� ✓,. �.7.',.�n'conoTnn i.7tir rc n�lu i,✓ °,�� r�r,,,, .',, ,,� ,..t „f „z,,.�”
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FIftE DEPFRmt N7 ❑ approved W/ comments O disappoued ❑ npsreieW required , Bldg Valuation: $
Description of Work (Exhibit A) Project PARK (GenRehab), EVE
Ite Descri 7350 WEST 44th PLACE, WHEAT RIDGE, CO 80033 -3460
Total Cost
Insulation
1 Attic Insulation (Energy Audit): Air seal leaks prior to insulation (see separate spec), block off the
top of dropped soffits or any chase, and seal the flue chase using sheet metal and fire -rated caulk.
Blow in additional cellulose insulation to a minimum of an R -40 in the attic. Also attach R -38
fiberglass batt or 8" extruded polystyrene form attached to the attic hatch.
$830.00
Doors
2 Entry Door (Rear) Remove existing, and provide and install new 32 "rear door w/ 112 lite, pre -hung,
primed, insulated, 1 3/4" thick, raised panel steel door. Include deadbolt lock set, adjustable
threshold, trim and site paint after installation. Owner to select color
ALSO: Install a new dog door (medium size) thru the wall next to the new rear door
$750.00
3 Add New Storm Door Provide and install new 32" storm door for the rear entry, pre - finished (color
selected by Owner), solid core, vinyl clad, in metal frame, self- storing w/ screen, lockable latch and
decorative grill.
$195.00
4 New Sliding Glass Doo r: Remove existing rear, sliding door (south) and provide and install new
pre- finished vinyl 5' sliding glass door with dbl glazed safety glass and screen. Trim and finish new
opening. Include keyed locking device plus safety /security bar.
$1,020.00
Windows
5 . Replacement Windows (8): Remove existing 8 older windows of the first floor of the house.
Prepare openings and existing sills. Provide and install new replacement windows, pre- finished,
vinyl, min. 2 1/8" frame, double glazed, low -e glass, residential windows with screens
(manufacturers: Cascade, Custom Gard II, 6500 Series, Xact, Alside or a rehab specialist
approved equal -- submit specs to the rehab specialist). New windows shall have the required
U- factor (0.30) to qualify the Owner for a rebate if eligible New windows shall have releases to lift
out for easy cleaning. For windows w/ existing muntins, new windows shall have grids to match.
All windows are to be installed according to the manufacturer's recommendations; insulated and
caulked around the openings, adjusted and lubricated. Owner to select color from stock colors
(up- charge for color other than white - -bid white).
Approx sizes: Dining (replace fixed): 71 x55 SVSL; Liv: 28x55 SH; Utility rm: 37x38 SH; SW bdrm:
57x35 SL, 47x35 SL; office and NW bdrm: 2 @ 44x57 SH plus (North) 47x57 SH.
$3,140.00
Interior Carpentry
Heat Resistant Wall Panels On the walls behind the free - standing wood burning stove, install
cement board panels (Owner has 2) to min of 4' along wall and to min 5' hgt. Add 12x12 tiles
(standard color and design as selected by owner).
$950.00
Appliances
7 Bathroom Vent Provide and install new ceiling mounted bath vent, 50cfm, with light (heating light)
in bathroom, vented to the exterior, and properly sealed at'the roof vent. The sound level shall not
exceed 5.5 sones. Contractor shall provide homeowner with a minimum one year warranty.
Provide separate switch controls.
$350.00
Printed: 1/6/2011 2:52:5913M Page 7 of 8
Lt -� e6f
'Description of Work (Exhibit A)
Item Description
Project PARK (GenRehab), EVE
7350 WEST 44th PLACE. WHEP
Plumbing
RIDGE, CO 80033 -3460 Total Cost
8 Bathtub Remove the existing bathtub in the bathroom. Furnish and install a new steel bathtub with
faucets, shower, a water conservation shower head (2 G.P.M. or less), non -skid bottom, and all
components for a complete installation.
$780.00
9 Bath Shower Tile Remove existing shower enclosure and backer board in the existing tub /shower
surround. Install new cement -fiber backer board. Properly prepare, furnish and install new ceramic
tile in the shower surround. Tile selection will be by the Owner from stock/standard tile. Work shall
include new shower rod and soap fixture. Also add new sliding shower doors.
$1,600.00
10 Exterior faucets Add new frost resistance valves /faucets for the two exterior sill cocks.
Heating /AC Systems
$260.00
11 Move Evaporative Cooler Move the existing' evaporative cooler from the existing window location
to a new through the wall opening constructed (trimmed and insulated) in the south living room
wall. Remount cooler and make all necessary connections.
$1,170.00
Electrical
12 Electrical System Upgrade /Additions Re- secure or replace meter mast. Add new drop to the
garage. Add two new exterior receptacles, front and back. Add to the existing service /breaker
panel new circuits if needed for dedicated circuits for the furnace and add GFI's in
kitchen /bath /laundry locations if not existing and arc faults to code. The electrical system shall be
brought into compliance with the local building code requirements for existing systems as best as
feasible and to make safe for the occupants.
Also add hard wired, interconnected smoke /fire detectors in accordance to the IRC and local code
requirements. Ceiling areas with access shall be hard - wired, but in the lower level or cathedral
ceiling areas without electrical ceiling access, smoke /fire detectors may be battery (long life)
operated or hardwired with interconnect system may be used (one hardwired alarm connected
wireless with the other alarms). Also add a new carbon monoxide alarm as required by Colorado
State statute.
Upgrade lighting to CFLs where possible throughout the property.
$3,060.00
Contract Total $14
AP PROVED
Subject to Field Inspections
Wheat Ridge Building Dept.
/
rI.
Printed: 1/6/2011 2:52:59PM Page 8 of 8
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.: WHEAT
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he Ridge Building Department
A proved 81/
DA '
1LD1 L
issuance of a permit or approval 01 plans, sp ecifications
e it: d for, r an approval of, any violation to
`
alidity P 8 ordinances.
and co ions shall not be a pelt!
any of the provisi ance
ons of the buildin code or of any Ciy
Permits presuming to give authority to violate or c l the provisions of the
building codes or other ordinances of the City shall not be Old-
APPROVED
Subject to Field Inspections
Wheat Ridge Building Dept.
Date���F /K
Sig ed. ..... /� ...... ..........Plan Checker
♦ 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: R.
Job Address:
Permit Number:
❑ No one available for inspection: Time PM
Re- inspection required: es No
When corrections have been made, call for re-in action at. -234 -5933
Date: L' HPJ2 Inspector: .7, ,
DO NOT REMOVE THIS NOTICE
" ' City of Wheat Ridge
►/ Residential Roofing PERMIT - 101932
PERMIT NO: 101932 ISSUED: 08/09/2010
JOB ADDRESS: 7350 W 44TH PL EXPIRES: 08/09/2011
DESCRIPTION: Reroof 21 sqs for house and garage with 30 yr Tamko shingl
* ** CONTACTS * **
owner 303/431 -7848 JHCA
sub 720/276 -2168 Stephen Wade 01 -9433 AW Exteriors
** PARCEL INFO **
ZONE CODE: UA
SUBDIVISION: 0009
USE: UA
BLOCK /LOT #: 0/
** FEE SUMMARY ** ESTIMATED PROJECT VALUATION: 5,500.00
FEES
Permit Fee 140.90
Total Valuation .00
Use Tax 99.00
** TOTAL ** 239.90
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
applicablvWheat Ridge Ordinances, for work under this permit. Plans subject to field inspection.
1. This permit was issued 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.
5. 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 rev w jeer to field inspections.
Signature of a uildin9 Official date
INSPECT N REQUEST LINE: (303)234 -5933 BUILDING OFFICE: (303)235 -2855
REQUEST MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
Ilk 01
t =5..lmilu rte tst; ,1�>��,nal-lvi `--
Plan tl
Building & Inspection Services Division
7500 W. 29" Ave., Wheat Ridge, CO 80033 Parrnit # J
Office: 303 -235 -2855 * Fax: 303 - 237 -8929
Inspection Line: 303 -234 -5933
Building Permit Application
Property Add sss'. / 3s-e) / a
Property Owner (please print): C Phone --q31 — 7a ?
Mailing Address: (if different than property address)
Address:
City, State, Zip;
Con4ractor: _ X 1�IO e
Contractors City License #: Phone: '7 20 - ",5 7.�'6 J
StrbCnntlaefii7�i
Electrical: Plumbing: Mechanical:
City License # City License # City License #,
.Taney 12 Contract Value:
$
Review Fee (due . at time of submittal):
Squares yl • BTU's Gallons Amps Sq Ft. $
OWNERICONTRACTOR 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 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: (O�W ONTRACTO l or (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR
PRINT NAME: U�� r SIGNATURE: —�I� Ci� DATE: 7 /U
ve...✓ c s ^s te r„ w . 2 /..^�,'� M� r L v / f �� s
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Bldg Valuation: $