HomeMy WebLinkAbout4320 Newland StreetFrom: no-reolv(alci.wheatridae.m. us
To: CommDev Pets
Subject: Online Form Submittal: Sewer or Water Line Repair Permit Application
Date: Tuesday, March 30, 20212:38:18 PM
Sewer or Water Line Repair Permit Application
This application is exclusively for SEWER OR WATER LINE REPAIR - IN YARD
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.
Right of Way permits must be applied for with the Public Works Department.
Is this application for Yes
sewer line or water line
repair - in yard only?
PROPERTY INFORMATION
Is this Residential or Residential
Commercial?
Property Address 4320 Newland St Wheat Ridge
Property Owner Name
Property Owner Phone
Number (enter WITH
dashes, eg 303-123-
4567)
Jeanette Lloyd
15#181s1:1801 E,19YAN
Property Owner Email david@elitepipemd.com
Address
Attach City of Wheat
Ridge Electronic
Payment Form - "DO
NOT ATTACH A
PICTURE OF A
CREDIT CARD"
CONTRACTOR INFORMATION
Contractor Business The Elite Pipe MD
Name
Contractor's License 120161
Number (This is a 5 or
6 digit number for the
City of Wheat Ridge)
Contractor Phone
720-662-4381
Number (enter WITH
dashes, eg 303-123-
4567)
Contractor Email
david@elitepipemd.com
Address
Retype Contractor
david@elitepipemd.com
Email Address
DESCRIPTION OF WORK
Is this a sewer line or
sewer Line
water line repair?
Length of repair
75'
Location of repair
Front yard
(backyard, frontyard,
etc)
Provide additional
Install dual sweep clean outs 4'-5' deep
details including
installation of clean-
o uts.
Project Value (contract
5200
value or cost of ALL
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 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 David salvidrez
Permit
Email not displaying correctly? View it in your browser.
1* � � i City of Wheat Ridge
�� E -Res. Sewer/Waterline Repair PERMIT - 202100587
PERMIT NO: 202100587 ISSUED: 03/31/2021
JOB ADDRESS: 4320 Newland St EXPIRES: 03/31/2022
JOB DESCRIPTION: Install dual sweep clean outs 4'-5' deep in front yard
*** CONTACTS ***
OWNER ( 7 2 0) 7 8 9- 4 3 7 7
LLOYD JEANETTE M
SUB (303)519-0240
R. ANDREW RUSSELL
120161 THE ELITE
PIPE MD
*** PARCEL INFO ***
ZONE CODE:
UA / Unassigned
USE:
UA / Unassigned
SUBDIVISION CODE:
2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#:
0 /
*** FEE SUMMARY ***
ESTIMATED PROJECT VALUATION:
51200.00
FEES
Total Valuation
0.00
Use Tax
109.20
Sub -Surface Sewer
0.00
** TOTAL **
109.20
*** COMMENTS ***
*** CONDITIONS ***
ALL sewer repair/replacements for which a permit is issued MUST be inspected by and receive
written approval from the City of Wheat Ridge BUILDING DIVISION, regardless of inspection
by any Sanitation District representative. Inspection and approval of work by any
Sanitation District representative DOES NOT grant authority to cover work without the
approval of the Building Division.
**For trenchless sewer replacements - The contractor will verify proper slope of new sewer
piping in conformance with the IRC and IPC of 1/4 inch per foot unless otherwise allowed
specifically by the applicable code. The plumbing contractor will provide verification of
proper slope and drainage in writing as a condition of approval of the permitted work.**
Both the front and back of this permit are required to be posted on the job site at all
times. If the complete permit is not present, inspections WILL NOT be performed.
1* � 4 41'
PERMIT NO:
JOB ADDRESS:
JOB DESCRIPTION:
City of Wheat Ridge
E -Res. Sewer/Waterline Repair PERMIT - 202100587
202100587
4320 Newland St
ISSUED: 03/31/2021
EXPIRES: 03/31/2022
Install dual sweep clean outs 4'-5' deep in front yard
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�permrt. I further attest that I am leg ally 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 document 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 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 requ�ired
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, anviolation of any provision of any
pplicab e code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection.
03/31/2021
Signature of Chief Building Official Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
�W
4;,2� Occupancy/T ie
INSPECTI IECORD
N
INSPECTION REQUEST LINE: (303) 234-5933
Inspections will not be performed unless this card is posted on the project site.
E
Call the inspection request line before 11:59 p.m. to receive an inspection the following business day.**
Inspector Must Sign ALL Spaces pertinent to this project
Foundation Inspections
Date Inspector Comments
Initials
Pier
ix / )t E
Concrete Encased Ground (CEG)
Foundation / P.E. Letter
Do Not Pour Concrete Prior To Approval Of The Above Inspections
Underground/Slab Inspections Date Inspector Comments
Initials
Electrical
Sewer Service
Plumbing
Do Not Cover Underground or Below/In-Slab Work Prior To Approval Of The Above Insaections
jRough Inspections
i
Date
Inspector
Initials
Comments
Wall Sheathing
Mid -Roof
ix / )t E
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 Piumbing
Final Mechanical
Roof
Final Window/Doors
�.
Final Building
NOTE: All items most 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.
"For Inspection Time Window — Please email insptimerequest@ci.wheatridge.co.us ci.Wheatridge.co.us by 8:00 A.M. the morning of the
inspection with the property address in the subject line of the email. Time window is based on the inspector's route.
Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued
Protect This Card From The Weather
♦ k-lty 01 ** i1cat t'.1k1gC
Y
Residential Roofing PERMIT - 201701041
PERMIT NO: 201701041 ISSUED: 05/31/2017
JOB ADDRESS: 4320 Newland ST EXPIRES: 05/31/2018
JOB DESCRIPTION: Reroof with OC storm shingles; 4/12 pitch - 19 squares
*** CONTACTS ***
OWNER (720)789-4377 LLOYD JEANETTE M
SUB (866)970-1133 Joseph Hoffman 090194 Hoffman Weber Construction Inc
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 4,883.00
FEES
Total Valuation 0.00
Use Tax 102.54
Permit Fee 125.05
** TOTAL ** 227.59
*** 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 spared
or board sheathing with ANY gap exceeding k/2 -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 manufacturera€ms 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's 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.
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: ilz? F
Job Address: '132-0 L)E WLA42 ST
Permit Number: 2 01-7 01 off( I
❑ No one available for inspection�Time ' ; 20 AM/PM
Re -Inspection required: Yes (` O
When corrections have been made, call for re -inspection at 303-234-5933
i 9
Date:_q/9 i 7 Inspector: �r
DO NOT REMOVE THIS NOTICE
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: 3 °
Permit Number:oZ 0
Dov f
❑ No one available for inspection: Time _ AM/PM
Re -Inspection required: Yes No
When corrections have been made, call for re -inspection at 303-234-5933
Date: Inspector: -
DO NOT REMOVE THIS NOTICE
i ,�' �COMMUNITY DEVELOPMENT
r r A #-
MEMMEM
Address:: v
City, State, Zip:
r wr
wr
(Fully destribe work to be performed - Attach additional shoot If natessary)
Erdan
Review Fee (due at tOw of subm itt a l) :
S Ft,
I
Building Pormit Application
(COMPIete 0 highlighted areas)
Spun
Gallons
Amps
Erdan
Review Fee (due at tOw of subm itt a l) :
S Ft,
I
Building Pormit Application
(COMPIete 0 highlighted areas)
► A City of Wheat Ridge O p
i .
-1�9� Residential Roofing PERMIT - 20120455 Lry
PERMIT NO: 20120455 ISSUED: 04/20/2012
JOB ADDRESS: 4320 Newland ST EXPIRES: 04/20/2013
JOB DESCRIPTION: Reroof 17 sqs with Class 4 Landmark Special shingles
* ** CONTACTS * **
OWNER (303)422 -0384 Bob Shirley
SUB (303)295 -7769 Robert Tichy 017911 Alpine Roofing Co., Inc.
* ** PARCEL INFO * **
ZONE CODE: UA / Unassigned USE: /
SUBDIVISION CODE: 0404 / CLARMOR HOMES BLOCK /LOT #: 0 /
* ** FEE SUMMARY * ** ESTIMATED PROJECT VALUATION: 7,989.00
FEES
Permit Fee 172.60
Total Valuation 0.00
Use Tax 143.80
** TOTAL ** 316.40
* ** COMMENTS * **
Original permit had wrong address of 4330 Newland Street. Changed project address to
reflect the correct address and sent copy of permit to contractor 05/09/12.
* ** CONDITIONS * **
6 nails per shingle is required. Ice dam membrane is required from eave edge to 2 & #39;
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.
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. Subject to field inspection.
' City of Wheat Ridge
Residential Roofing PERMIT - 20120455
PERMIT NO: 20120455 ISSUED:
JOB ADDRESS: 4320 Newland ST EXPIRES:
JOB DESCRIPTION: Reroof 17 sqs with Class 4 Landmark Special shingles
04/20/2012
04/20/2013
1, by my signature, do hereby de
attest that the work to be performed shall comply with all accompanyingg approved plans and specifications,
applicable building codes, and all applicable municipal cos, 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 1 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 document 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, po icies and procedures.
?, 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 pennit 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, an violation of any provision of any
applicable code 9j an) y&Winance or regulation of this jurisdiction. Approval of work is subject to field inspection.
Signature of'Chief Building Official Date
REQUESTS MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
Mai 08 2012 9:44RM 81pine Roofing Co., Inc. 3032966803
• ALPINE ROOFING CO., INC.
4780 YORK STREET
DENVER CO 80216
• 303 -295 -7769 FAX (303) 296.6803
To: Permit Dept Fax #: 303 -237 -8929
From: Den C Date: 5/8/12
Re: Permit #120455 Pages: ( Including cove p 1
For Review d Please Comment ❑Please Rq* * ❑ Pisses Revery •
M k
the address on this permit ( #120455) to 4320 Newland St.
Ffease fax over a revised copy of the permit to me at 303 -296 -6803.
Thank you. Please call me with any questions.
Denvell
p.I
. . . . . . . . . . . . . . . . . . . . . . .
Date:
Plan #:
pennit #:
4330 NEWLAND ST
Property Owner (please ptint): BOB SHIRLEY
i
:83 � :#
Contractor: ALPINE ROOFING CO- INC
Contractor License M 9791 1 Phone: 303-295-7769
M� 1
DEPARTMENT OF PLANNING AND DEVELOPMENT Building Permit Number : 12447
BUILDING INSPECTION LINE - 303-234-5933 Date : 7/11/01
CITY OF WHEAT RIDGE
7500 WEST 29TH AVENUE
WHEAT RIDGE, CO 80215 - (303-235-2855)
Property Owner :
Property Address : 4320 NEWLAND ST Phone : 422-4823
Contractor License No. : 17152
Company : Precise Plumbing Phone : 534 0881
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 the Wheat Ridge Building
Code (U.B.C.) and all other applicable Wheat Ridge ordinances, for work under this permit.
(OWNER)(CONTRACTOR) SIGNED DATE
Construction Value :
$445.00
Permit Fee :
$23.50
Plan Review Fee :
$0.00
Use Tax :
$0.00
Total:
$23.50
Use:
Description : REPLACE WATER HEATER, READY FOR INSPECTION.
T-S M'_
BUILDING DEPARTMENT USE ONLY
:
Z'l~..xe.~a . SIC: Sq. Ft.
Approval :
Zoning :
WITO
Approval :
,F~
Approval :
Occupancy : Walls : Roof : Stories : Residential Units :
Electrical License No :
Company :
Expiration Date :
Approval:
Plumbing License No :
Company:
Expiration Date :
Approval:
Mechanical License No :
Company :
Expiration Date :
Approval :
(1) This permit was issued in accordance with the provisions set forth in yopur application and is subIect to Ihe laws of the State of Colorado antl to the Zoning
Regulations and Building Code of Wheat Ridge, Colorado or any other applicable ordinances of ihe Ciry,
(2) This permit shail expire if (A) the work authorized is not commenced wM1hin sixty (60) days from issue date or (B) the building authorized is suspendetl or
abandoned for a period of 720 days.
(3) If this permit expires, a new permR may be acquiretl for a fee of one-half the amount normally requireQ provitletl no changes have been or will be made in the
original plans and specifications and any suspension or abandonment has not exceetled one (1) yeac If changes are made or if suspension or abantlonment
exceeds one (1) year, full fees shall be paitl for a new permit.
(4) No work of any manner shall be done that will change ihe natural Flow of water causing a drainage problem.
(5) Contractor shall notdy the Building Inspector lwenty-four (24) hours in advance for all inspeclions and shall receive written approval on inspection card before
proceediin 'lh success hases of the1ob.
(6) Thi issu itl ce f a Y t~he PQrdinal~of d awingae otlregulationtions shall not be consirued ro be a permii for, nor an approval of, any violalion of the provisions
DEPARTMENT OF PLANNING AND DEVELOPMENT Building Permit Number :
BUILDING INSPECTION DIVISION - 235-2855 .
CITY OF WHEAT RIDGE Date :
7500 WEST 29TH AVENUE
WHEAT RIDGE, CO 80215
Property Owner :
L13 o /V,"
/ 7/ T-:.Z
Phone : y2 4 ra 3
Property Address :
Contractor License No. :
companv Pi P cis cX/~m c-
Phone : s'3y-o 8'sr'/
~ OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT
1 hereby eertAy that Ne setbadc tlistances OroOOSeE oy this pertmc ap0iication ara acarats.
an0 tlo not woute aoo4pbk ominances. rubs or reguuuons of Ne Cily of WAeat RiOge or
covsnanu. easemenq or restnctions of raeorE: Nat 7Y meuurcrroms shown. anG albqatqns
;ma0! am aCCUnte: Nat I Ilavs fOatl an0 aqIOR t0 aDdO Dy aY con0i00ns pnnMtl on Utii
appYeatlon. ana mat I assume lull roapawDtliN for compnsnea wtn Me WMat Ridge Building
CoOe (U.B.C.) antl all oMer appiipbls Whsat Rdya oramsncas. tor work unCSr Mu psrmt
(OWNER)(CONTiL4CTOR)SIGNEDlO'~ t-.~ pqTE
ConsVuction Value : Y S
Pertnit Fee :.23i S c,
US@ T2X PCS-o~L
TOhd1:~23 7 G ~
F~/- i n~p~ s~'oH
Description : c t e-4-{~~ i1ro{•,-- 7
BUILDING DEPARTMENT USE ONLY
~Qb~n2fiC
Approval :
Zoning :
~ll~`thr~~
Approval :
r~t~= UrNHft"
Approval :
Occupancy : Walls
Roof : Stories : Residential Units :
Electncal license No :
Company :
Expiration Date :
Approval:
_g ~:Plins'RSqufrea=
Plumbing License No :
Company:
Mechanicaf License No :
Company :
Expiretion Date :
Approval :
P1Ylis RGI
juired'•`- ~
Expiratlon Date :
Approval :
~_:kr, !J:
(1) This permrt was uwca m acmraance wm tne pontqns fM Ipm n yopur aoplCaoon an0 o suONQ ro IM Wws W IM Stau d CobqOO uW Oo tlN 2orWp
RepWauons aro Builortg Coaa of Wheat iLtlqa. Co:onoo a ury anx aopunde oroInanns ol ma Cily.
(2) n+~s oemrt snLl eapua R IAl lna worK auafonxee u rot eommsnoep w,oun wry 160) aaYS hom osw Wb w(B) IM WYCuq auUionxao u suapubaC ot
aWn0ona0 Mr a perq0 of 120 CaYi
(7) it we pe1mn a.ovaa. a n" osmn mry wAcvwna br a fN W oro.run ms amount normauy, reuuvW. povqb no wn"a nave ewi a wIN 0e rtua n tM
orpwi Wans ana speadkaoona ana arry waosnwn a awnaonmont nu not exuww a+s (1) yer. it wim ue mwa a A wspunqn aawnaavnem
ax00e0f one 11) Yeu. lull h!7 sMY Oa wtl IDf a nM wfRM.
(4) No wonc of any rtunnn fnsu De aona aut wYl Wnqe cy nanual now of wsnr au9nq a anma9e proEWn.
(5) Convaaor snan rouN me Buiwing insoaaor nvemyaau I74) houw m awanea ror au mspaeoons ara Snaq racnre wnttan aoProv+l ui u+swmm aa bel«~
proceeCiinq wim successne onases of Ne po.
(6) TTe uswnr< of a Dermt or tne aoorpva of 0nvnnqa ana sDeoRanona snan nOt Oa mnswetl W De a pertM fpr. rqr an aPOmval o/. any viWOOn W M wwoaru
ot me ounamq moes or any oma oramana, uw. ro:e a reqwuon.
Chief Bwlding Inspector
For Mayor
THIS PERMIT VALID ONLY WHEN SIGNED BY THE CHIEF BUILDING INSPECTOR AND AAAYOR
CALL: 2345933 24 HOURS PRIOR TO INSPECTION
*0 • a . 11" 1 # • . • I
Property Address:
Property Owner (please print): i3o t. rlel-1 Phone:
Address
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, casements or restrictions of record; that all measurements shown and
allegations made are accurate; that I have read and agree to abide by all conditions printed on this application and that I assume full
responsibility for compliance with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on
this application; that I as the legal owner or have been authorized by the legal owner of the property to perform the described work
and area also authorized by the legal owner of any entity included on this application to list that entity on this application,
rj= NAME. Lot� Z S1(;NATVR&, AATE,