HomeMy WebLinkAbout4650 Everett StreetCity of
W heatdge
COMMUNITyDEVELOPMENT
Date:
Plan #
Building & Inspection Services Division Permit #
7500 W. 29th Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-237-8929
Inspection Line: 303-234-5933
Building Permit Application
property Address: ((p q0 Yd Ll4o y~JA l,'1 ~J r
Property Owner (please print): 1 ill,, }me54,1-p ex Phone y ~l-?
Mailing Address: (if different than property address)
Address: -7t ,~,5 a' A u6~
City, State, Zip:1 n o0~ Co 6 11 ;I
Colrtracton: Lj pI y`~4Sfg l o d'`(~ l li'}CoA4.0'(S
Contractors City License Phone:.' ®ol ~oC 7 fir; 6
Plumbing:
Mechanical:
City License # City License # City License #
T~es~r~~tto
AK ` -0 n'`o#/yvork
` / / no
I 3 14 LL~~~ ~U/C < Contract Value:
$ P2 L! $s
1 0 / k o
%s e(L OA-1 c;+u-Ipls 3O f00".7~e C
V OL ? A hl k0 A 190 > d~ L/ >r '2- Review Fee (due at time of submittal):
Squares ^7 BTU's Gallons Amps Sq FL
OWNERICONTRACTOR 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 I 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) CONTRACTp~OR~o/rr (AUTHORIZED REPRES TATIVE)~of` (OWNER) (CONTRACTOR) 't
PRINT NAME-0 SIGNATURZ*
V o" DATE: ° d
,.,_,s:, ,G rDEPi4RTIVINT:l1s€OyYr, n * 2 . r
✓ : rtev~ewer
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J Bt1IL'DING DEPARTMENT pep" El
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'PU811G~YVORKS COMMENTS
RevleWer
FIRE))~PARrMENY ❑ approve
r
Bldg Valuation:
lRM (E) 414-02.5147
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PUBLIC SERVICE COMPANY OF COLORADO
-- WARNING
THE'CONOITION FOUNO, AS SHOWN BelOW, IS NOT INCOMPLIANCE WITH CURRENtlY ACCEPTED pRACTICES AND
PROCEDURES AND COULD, CREATE A HAZARD, CORRECTIONS, SHOULD BE MADE BY A OUAlIFIED pONTRACTOR, CONTACT
YOUR LOCAL ILDlNG OEPARTMENT FOR CODE AND ERMIT R~OUlREMENTS PRIOR TO PERFORMING R~PAIR WORK,
eS-
FOR FURTHE'R INFORMATION, PHONE:
""7 ( D"'V,;J- 7~ '7 :1
TIME
DATE
HIP OF OCCUPANT TO CUSTOMER
I
) FOAM IKI 414-02-1123
PUBLIC SERVICE COMPANY. Qf COLORADO
,'Q.1120
u 'V ~'r
FLOOR
APT. NO
, OWNER 0
I
HAZARD
CONDITION TO BE CORRECTED AS SHOWN BHOW CREATES AN IMMEDIATE HAZARD. THIS EDUiPMENT MUST NOT BE PUT BACK iN
I SERVICE UNTIl REPAIRS AND A THOROUGH INSPECTION HAVE BEEN MADE BY A QUALIFIED CONTRACTOR, CONTACT YOUR lOCAL
BUilDING DEPARTMENT FOR CODE AND PERMIT REOUIREMENTS PRIOR TO PERFORMING REPAIR WORK
I NA
I
(./
<7'5-
A()I
FOR FURTHER INFORMATION, PHONE,
TIME
II 5;;lfY\
TIME '
DATE
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