HomeMy WebLinkAbout9461 W. 47th AvenueCity of Wheat Ridge
Residential Roofing PERMIT - 201703005
PERMIT NO:
201703005
ISSUED:
07/01/2017
JOB ADDRESS:
9461 W 47th AVE
EXPIRES:
07/01/2018
JOB DESCRIPTION:
Residential Re -roof to install
CertainTeed Architectural asphalt shingles -
10 sq. (8 sq. pitched / 2 sq.
flat)
*** CONTACTS ***
OWNER (720)216-7218
NG TIP LAN
SUB (720)446-7802
Joel Scholz
130188 Retep Construction
*** PARCEL INFO ***
ZONE CODE:
UA / Unassigned
USE:
UA / Unassigned
SUBDIVISION CODE:
2946 / MANSFIELD
BLOCK/LOT#:
0 /
*** FEE SUMMARY ***
ESTIMATED
PROJECT VALUATION:
2,570.00
FEES
Total Valuation
0.00
Use Tax
53.97
Permit Fee
93.35
** TOTAL **
147.32
*** 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.
701703cry �_
INSPECTION RECORD ° cu anc r
INSPECTION ONLINE FORM: rittp://www.ci.wheatridge.co.us/inspection
INSPEC i ION REQUEST LINE: (303) 234-5933
Inspections will not be performed unless this card is posted on the project site.
**Request an inspection before 11:59 p.m. (midnight) to receive an inspection the following business day.**
Inspector Must Sign ALL Spaces pertinent to this project
Foundation Inspections
Date Inspector Comments
Initials
Pier
Sewer Service
Concrete Encased Ground (CEG)
Plumbing
Foundation / P.E. Letter
Mid -Roof
Do Not Pour Concrete Prior To ADDroval Of The Above Inspections
Underground/Slab Inspections
Date Inspector Comments
Initials
Electrical
Comments
Sewer Service
Plumbing
no Not Cover Underground or Below/In-Slab Work Prior To Approval Of The Above Inspections
Rough Inspections
Date
Inspector
Initials
Comments
Wall Sheathing
Mid -Roof
Lath / Wall Tie
Rough Electric "
Rough Plumbing/Gas Line
Rough Mechanical
Rough Framing
Rough Grading
Insulation
Drywall Screw / Nail
Final Inspections
Date
Inspector
Initials
Comments
Landscaping & Parking / Planning Dept.
Inspections from these entities should be requested
one week in advance. For landscaping and parking
inspections call 303-235-2846. For ROW and drainage
inspections call 303-235-2861. For fire inspections
contact the Fire Protection District for your project.
ROW & Drainage / Public Works Dept.
Floodplain Inspection (if applicable)
Fire Inspection / Fire Protection Dist.
Final Electrical
Final Plumbing
Final Mechanical
Roof
1
Final Window/Doors
Final Building
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 from the Fire District and electrical low voltage
by the Building Division.
Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued
Protect This Card From The Weather
City of Wheat Ridge
Residential Roofing PERMIT - 201703005
PERMIT NO: 201703005 ISSUED: 07/01/2017
JOB ADDRESS: 9461 W 47th AVE EXPIRES: 07/01/2018
JOB DESCRIPTION: Residential Re -roof to install CertainTeed Architectural asphalt shingles -
10 sq. (8 sq. pitched / 2 sq. flat)
*** CONTACTS ***
OWNER (720)216-7218 NG TIP LAN
SUB (720)446-7802 Joel Scholz 130188 Retep Construction
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2946 / MANSFIELD BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 2,570.00
FEES
Total Valuation 0.00
Use Tax 53.97
Permit Fee 93.35;
** TOTAL ** 147.32 - --- --.-
*** 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
ffl lar
Residential Roofing PERMIT - 201703005
PERMIT NO: 201703005 ISSUED: 07/01/2017
JOB ADDRESS: 9461 W 47th AVE EXPIRES: 07/01/2018
JOB DESCRIPTION: Residential Re -roof to install CertainTeed Architectural asphalt shingles -
10 sq. (8 sq. pitched / 2 sq. flat)
1, by m 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 document as parties to the work to be
performed arld-thar-ali work to be performed is disclosed in this document and/or its' accompanying approved plans and specifications.
Signature of OWNER or .CONT k C 'ORircle one) Date
i. This permit was issued based the inf6nnation provided in thepermit 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 changeof the natural flow of water without prior and specific approval.
5. The permit border 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 c any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection.
o ,
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 insptimerequest@ci.wheah-idge.co.us
between 7:30am and 8:00am, the morning of the inspection. Please put the address of the inspection in the subject line.
Dane Lovett Uo
170 � 0 J
From: no-reply@ci.wheatridge.co.us
Sent: Tuesday, June 20, 2017 12:44 PM
To: Permits CommDev (�
Subject: Online Form Submittal: Residential Roofing Permit Application
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 G
contractor's license or insurance has expired, and you may update those S
documents at the time you are issued your permit. Permits are currently being
processed within 3-5 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. n� % wn' �� ����
Is this application for a Yes �/� rl /CC
residential roof?
How many dwelling units Single Y le Famil Home Ins eK1 (t�
are on the property? U(� Q/ (7
PROPERTY INFORMATION
Property Address
Property Owner Name
Property Owner Phone
Number
Property Owner Email
Address
9461 W 47th Ave
Tip Ng
720-216-7218
Field not completed.
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
Contractor's License
Number (for the City of
Wheat Ridge)
Contractor Phone
Number
Retep Construction
130188
7204467802
Contractor Email Address tracey@retepconstruction.com
(permit pick-up
instructions will be sent
to this email)
Retype Contractor Email tracey@retepconstruction.com
Address
DESCRIPTION OF WORK
Are you re -decking the
roof?
Description of Roofing
Material
Select Type of Material
If "Other" is selected
above, describe here:
No_,_�
Certainteed Architectural Asphalt Shingles
Asphalt
Field not completed.
How many squares of the 8
material selected above?
Does any portion of the Yes .�
property include a flat
roof?
If yes, how many squares 2
on the flat roof?
01
TOTAL SQUARES of all
roofing material for this
proj ect
Provide additional detail
here on the description of
work. (Is this for a house
or garage? What is the
roof pitch? Etc)
10
flat roof is the carport behind house
Project Value (contract 72569-M
value or cost of ALL
� �70
materials and labor
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 Joel Scholz
Email not displaying correctly? View it in your browser.
3
Retep Construction LLC
(720)446-7802
www. RetepConstructfon. com
ESTIMATE
ADDRESS
9461 W 47th Ave
Wheat Ridge, Colorado 80033
United States
ESTIMATE # 1340
DATE 06/06/2017
EXPIRATION DATE 07/0612017
ACTIVITY
AMOUNT
Labor • Remove and replace 25 year comp shingles, telt, ice and water, flashing, vents, jacks
2,012.91
Includes high roof charge 2 stories and trash access charge
Materials
1,197.00
25 year comp shingles
0100
Ice and water shield per code requirement
0.00
Drip edge
0.00
Flashing for transition to neighbors roof - town home has attached roof
0.00
Turtle vents 3
0.00
Pipe jacks 2
0.00
Plastic caps and coil nails
0.00
Roofing Cement
0.00
Furnace vent rain cap and storm collar
0.00
Material taxes
98.43
Dump Charge
250.87
Permit
100.00
7.60 Squares (9 with waste). Estimate does not include mansard roof in front as it does not appear to be
damaged. Includes only upper roof, does not include patio covers or car ports. Price only valid if roof is
completed at the time of all neighbor roofs attached to townhomes.
Discount for performing all roofs at one time. Color will be selected by contractor in order to match other roofs.
•459,21
Mansard (front of house) not included.
This is an estimate only, all prices and terms are subject to TOTAL '�oo'O�
change upon agreement of work. Price is only valid if there are
no changes tram work outlined on this estimate. If additional work
is requested, new prices will also be subject to agreement.
Accepted By Accepted Date
9463 W 47th Ave, Wheat Ridge, CO 80033
x -
s 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: 0
Job Address: W �7 "
Permit Number: U3yv F-
❑ No one available for inspection: Time 0?.M/PM
Re -Inspection required: Yes �0)
*When corrections have been made, callforre-inspection at 303-234-5933
Date: DU/h( Inspector: K
DO NOT REMOVE THIS NOTICE
6v;- t p
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: V F
Job Address: X/6 I H 4 L
Peirmit Number: - -%7U GvS
'0
❑ No one available for inspection: Time U, (/L4M/PM
Re -Inspection required: Yes No
When corrections have been made, call for re -inspection at 303 -234 -
Date: -7/
03 -234 -
Date:%/ I Z7//7 Inspector: t<C
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.
7 7 7/r / A , : -)- Cp A / TI Aro e / n e
, v
INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS JOB
FOUNDATION INSPECTIONS
DATE
INSPECTOR
I ITIALS
COMMENTS:
Footings /Caissons
Stemwall I (CEG) Concrete
Encased Ground
-
Reinforcing or Monolithic
Weatherproof / French Drain
Sewer Service Lines
Water Service Lines
INSPECTIONS FOR PLANNING & ZONING, FIRE AND PUBLICE WORKS
SHOULD BE CALLED AT LEAST ONE WEEK PRIOR TO FINAL INSPECTIONS.
rvurt rv� 1. Vrvl.rte I= UN I1L FkBVVE NAb OLEN WUNED
CONCRETE SLAB FLOOR
Electrical (Underground)
Plumbing (Underground)
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
ABOVE INSPECTIONS TO BE SIGNED PRIOR TO PROCEEDING
Framing
Insulation - -
Drywall Screw
FINALS
Electrical
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
t
♦ 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:
Job Address: ?' 1 Gl G
Permit Number: f 1
1r ?�J�
O No one available for inspectio _1 ` ime AM /PM
Re- Inspection required: Yes N
"When corrections have been made, callfor re- Inspection at 303-234-5933
Date: Inspector: /
DO NOT REMOVE THIS NOTICE
" 41 City of Wheat Ridge
_
Commercial Mechanica PERMIT - 102594
PERMIT NO: 102594 ISSUED: 11/18/2010
JOB ADDRESS: 9461 W 47TH AVE EXPIRES: 11/18/2011
DESCRIPTION: Run new gas lines, move all meters for meter bank
* ** CONTACTS * **
owner 720/341 -0230 Owner /Occupant
sub 303/430 -1414 Lee Wilkerson 10 -0353 Kelly Cable Corporation
** PARCEL INFO **
ZONE CODE: UA USE: UA
SUBDIVISION: 0244 BLOCK /LOT##: 0/
** FEE SUMMARY ** ESTIMATED PROJECT VALUATION: 1,000.00
FEES
Permit Fee 43.50
Total Valuation .00
Use Tax 18.00
** TOTAL ** 61.50
Conditions:
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 document as parties to the work to be performed and that all work to be performed is disclosed in
this do ant/ �nying approved plans and specifications.
� / -o`v� -o
Signature of OWNER or CONTRACTOR (Circle 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.
S. 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 inspection.
Signature of C lding Offical Date
INSPECTIO RE EST LINE: (303)234 -5933 BUILDING OFFICE: (303)235 -2855
REQUESTS 'MUST BE MADE BY 3PM ANY BUSINESS DAY FOR .INSPECTION THE FOLLOWING BUSINESS DAY.
L It) ut
� 6
I IN IY D iVf 1 1PMFN1
Building & Inspection Services Division
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' —L 96/ w (art ti+-
Property Owner (please print):
Phone:
Mailing Address: (if different than property address)
r /lie
Address: fM. N l f`4 I7rOU� elfin
[f .t nrl
City, State, Zip:
D kn(hi;�r 8022/ _.
Contractor:
Contractors City License #: O�GYLp / Phone: 7.0 -3 - 0230t 3 -y3o -1'114
Sub Contractors: —'
Electrical: Plumbing: Mechanical:
City License # City License # City License #
( WerK 28 For ) (C.PS E�nn
Descri2tion of work: P., 17e x.) � Servrrz�0
Of by -ddi� ; aAd Inme a /[ 9� �,� , �, we-r+ P„d
-to /Ndl K �l� Rw� frk�r✓ � O�' bu ld +'rte con tact value:
I hG f-o $� ���. !1�
A014 -from 4 e r Nr&r o-+ flit nie -for bank. All
born in betold gran- • Pj5 _145 Q fee— IN i If for uSEd
- Fueled -to 3dger, >?(ryo( r
2[I x& f" Review Fee (due at time of submittal):
BTU's Gallons
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 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: (OWNER) (CONTRACTOR) or (AUTHORIZED REPRESENTATIVE) j. (OWNER) (CONTRACTOR)
PRINT NAME: /�
n &q SIGNATURE: DATE: _
ZONING COMMENTS:
Zoning:
Reviewer.
BUILDING DEPARTMENT COMMENTS:
Reviewer.
PUBLIC WORKS COMMENTS:
Reviewer.
OCCUPANCY:
DEPARTMENT USE ONLY
FIRE DEPARTMENT:: C approved v✓/ comments ❑ disapproved ❑ no review required I Bldg Valuation:
rlar �
IIII
Phone:
Mailing Address: (if different than property address)
r /lie
Address: fM. N l f`4 I7rOU� elfin
[f .t nrl
City, State, Zip:
D kn(hi;�r 8022/ _.
Contractor:
Contractors City License #: O�GYLp / Phone: 7.0 -3 - 0230t 3 -y3o -1'114
Sub Contractors: —'
Electrical: Plumbing: Mechanical:
City License # City License # City License #
( WerK 28 For ) (C.PS E�nn
Descri2tion of work: P., 17e x.) � Servrrz�0
Of by -ddi� ; aAd Inme a /[ 9� �,� , �, we-r+ P„d
-to /Ndl K �l� Rw� frk�r✓ � O�' bu ld +'rte con tact value:
I hG f-o $� ���. !1�
A014 -from 4 e r Nr&r o-+ flit nie -for bank. All
born in betold gran- • Pj5 _145 Q fee— IN i If for uSEd
- Fueled -to 3dger, >?(ryo( r
2[I x& f" Review Fee (due at time of submittal):
BTU's Gallons
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 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: (OWNER) (CONTRACTOR) or (AUTHORIZED REPRESENTATIVE) j. (OWNER) (CONTRACTOR)
PRINT NAME: /�
n &q SIGNATURE: DATE: _
ZONING COMMENTS:
Zoning:
Reviewer.
BUILDING DEPARTMENT COMMENTS:
Reviewer.
PUBLIC WORKS COMMENTS:
Reviewer.
OCCUPANCY:
DEPARTMENT USE ONLY
FIRE DEPARTMENT:: C approved v✓/ comments ❑ disapproved ❑ no review required I Bldg Valuation: