HomeMy WebLinkAbout2718-2726 Fenton Street6/2010
3/2010
n
e a , City of
Wheat midge
COMMUNITy DEVELOPMENT
Building & Inspection Services Division
7500 W. 29th Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-237-8929
Inspection Line: 303-234-5933
Building Permit Application
Date:
Plan #
Permit
-5 L> 19; ;kc
Property Owner (please print): ~Yy f a Phone: j07-q/ 6 -
Mailing Address: (if different than property address)
Address: 7 A L7
City, State, Zip:
J
cor%tractor: o - a l~,l"tCn7Y<' Contractors City License Phone: jd %/'"7- (,6 L
$ubContraetors
Electrical: Plumbing: Mechanical:
City License # City License # City License #
bpescrttitiotnf w~rlcf y"~'
l~ o C1G - ~Q - D Contract Valued .r~ ,
J $ t' qp~
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 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) (CONTRACTOR) ar (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR)
PRINT NAME: SIGNATURE: DATE:
I approved W/ conl!?nts ❑ d~sapprovsrl ❑ po slew je'1~mred, Bldg Valuation: $