HomeMy WebLinkAbout3505 Fenton StreetFrom: no-reolv(alci.wheatridae.m. us
To: CommDev Pets
Subject: Online Form Submittal: Air Conditioner/Evaporative Cooler Permit Application
Date: Thursday, September 23, 20213: 12:44 PM
Air Conditioner/Evaporative Cooler Permit Application
This application is exclusively for AIR CONDITIONER OR EVAPORATIVE
COOLER.
YOU MUST ATTACH THE ELECTRONIC PAYMENT FORM IN ORDER FOR
THE PERMIT TO BE PROCESSED.
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.
PROPERTY INFORMATION
Is this a new install or
Replacement of Existing Unit
replacement for an
existing AC unit?
Is this Residential or
Residential
Commercial?
Property Address
3505 Fenton St
Property Owner Name
Sandra Glennon
Property Owner Phone
303-432-8046
Number (enter WITH
dashes, eg 303-123-
4567)
Property Owner Email
rmclark11@ymail.com
Address
Attach City of Wheat
WR Payment Form.odf
Ridge Electronic
Payment Form - "DO
NOT ATTACH A
PICTURE OF A
CREDIT CARD"
CONTRACTOR INFORMATION
Contractor Business
Top Shelf Electric, Heating & Air
Name
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 Ryan Clark
Permit
Email not displaying correctly? View it in your browser.
Contractor's License
210228
Number (This is a 5 or
6 digit number for the
City of Wheat Ridge)
Contractor Phone
720-899-2633
Number (enter WITH
dashes, eg 303-123-
4567)
Contractor Email
info@topshelfhomeservice.com
Address
Retype Contractor
info@topshelfhomeservice.com
Email Address
DESCRIPTION OF WORK
What type of
Evaporative Cooler
replacement unit are
you installing?
How many tons is the
0
unit?
For AC - what is the
4500
SEER?
For Evaporative
Coolers, what is the
CFMs?
Where is the unit
Rooftop
located (for example,
rooftop, backyard on
ground etc)?
Is electrical needed for
No
re -hook?
Project Value (contract
3500
value or cost of ALL
materials and labor)
SIGNATURE OF UNDERSTANDING AND AGREEMENT
I assume full
Yes
responsibility for
compliance with
applicable City of
I* � 4 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: F-1 44a,
Job Address: �—IDS J
Permit Number: 'Zok:] O h0014-
'R
❑ No one available for inspection: Time 6 ✓ 5 MMM
Re -Inspection required: Yes 9
When corrections have been made, call fvr re-mspectio(n at 303-234-5933
Date: 2� I 6MA�c Inspector:
DO NOT REMOVE THIS NOTICE
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:1Qh�,4�1��}-� � DC*--
Job Address: '�'"➢ r= �"r
Permit Number: 2C�1"j 0
1►7 1 1C 'r
❑ No one available for inspection: Time( S AMP M
Re -'Inspection requiredYe
When corrections have been e, peal fo re -inspection at 303-234-5933
Date: -h Inspector:
DO NOT REMOVE THIS NOTICE
1* � 4 i CITY OF WHEAT RIDGE
Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax '
INSPECTION NOTIC
f �Cr
Inspection Type:
Job Address: 3 S_O Sr fL'i
Permit Number:
C
❑ No one available for inspection: Time Z 1a/AM/pm
Re -Inspection required: Yes (,� No '
When corrections have been made, call for�ree-inspe io 303-234-5933
Date: /" J Inspector:
DO NOT REMOVE THIS NOTICE
i CITY 0F`WHVAT RIDGE
Building Inspection Division
(303) 234-5933 Inspection .line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: vif--,'
Job Address:
Permit Number:
❑ No one available for inspection: Time/L4, /
Re -Inspection required: ,' Y
7° No
}
When corrections have beentm'ade, call for re -inspection at
Date: Inspector: 'w
City of Wheat Ridge
Residential Roofing PERMIT - 201708094
f
PERMIT NO: 201708094 ISSUED: 10/09/2017
JOB ADDRESS: 3505 Fenton ST EXPIRES: 10/09/2018
JOB DESCRIPTION: Residential Re -roof to install OC asphalt shingles - 27 sq Pitch = 5/12
*** CONTACTS ***
OWNER (303)432-8046 GLENNON GREG L
SUB (303)763-9114 Scott Riopelle 019938 Interstate Roofing Incorporate
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2412 / LAKESIDE, STEWART GARDENS, OLI BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 6,939.00
FEES
Total Valuation 0.00
Use Tax 145.72
Permit Fee 156.75
** TOTAL ** 302.47
*** COMMENTS ***
*** CONDITIONS ***
Midroof & Final Roof inspections for ROOFS 6/12 PITCH & OVER: 3rd party inspection will be
required for both the midroof and final inspections. The 3rd party inspection report AND
THE ORIGINAL PERMIT CARD needs to be dropped off to the Permit Desk at the City of Wheat
Ridge. The report MUST BE SIGNED by the Homeowner.
REGARDING ROOF VENTILATION: Roof ventilation shall comply with IBC Sec. 1203.2 or IRC Sec.
R806. The installation of ridge venting requires the installation or existence of soffit
venting. For calculation purposes, one hat or turtle vent equal to one-half of one square
foot of opening.
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) is required on the entire roof
when spaced or board sheathing with ANY gap exceeding one half inch exists. Sheathing and
mid -roofs may be called in at the same time, one hundred percent of the sheathing must be
complete and 25-75 percent of the mid -roof may be complete. 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.
f City of Wheat Ridge
Residential Roofing PERMIT - 201708094
PERMIT NO: 201708094 ISSUED: 10/09/2017
JOB ADDRESS: 3505 Fenton ST EXPIRES: 10/09/2018
JOB DESCRIPTION: Residential Re—roof to install OC asphalt shingles — 27 sq Pitch = 5/12
I, by my signature, do hereby attest that the work to be performed shall comply with all accompanyingg 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 le ally authorized to include alI entities named within this document as parties to the work to be
performed and that all work to be ormed is d closed in this document and/or its' accompanying approved plans and specifications.
Signature of OWNER or CONTRACT ( a one) Date r
I , 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, po icies 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 originalpermit 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 inspection.
Signature of Chief Building Official T ` Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
Dane Lovett Z c, ! 7 o q
From: no-reply@ci.wheatridge.co.us
Sent: Wednesday, October 4, 2017 12:28 PM
To: CommDev Permits
Subject: Online Form Submittal: Residential Roofing Permit Application
Follow Up Flag: Follow up
Flag Status: Completed
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 and due to the volume of requests, time to process
varies and is subject to change. 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 contractor's license or insurance has expired, and you may update those
documents at the time you are issued your permit.
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.
pp J_
Is this application for a Yes L '' ���� (7
residential roof?
How many dwelling units Single Family Home
are on the property?
PROPERTY INFORMATION
Property Address
Property Owner Name
Property Owner Phone
Number (enter WITH
dashes, eg 303-123-4567)
3505 Fenton St OL
Greg Glennon
303-432-8046
�7
49
Property Owner Email jwiles@interstateroof.com
Address
Do you have a signed Yes
contract to reroof this
property?
Applications cannot be
submitted without an
executed contract
attached below.
Attach Copy of Executed contract.pdf
Contract
CONTRACTOR INFORMATION
Contractor Business Interstate Roofing
Name
Contractor's License 93$—
Number (This is a 5 or 6
digit number for the City 019 5:3 K
of Wheat Ridge)
Contractor Phone
303-763-9114
Number (enter WITH
dashes, eg 303-123-4567)
Contractor Address
1000 W 47th Ave
(Primary address of your
business)
Contractor Email Address
jwiles@interstateroof.com
Retype Contractor Email
jwiles@interstateroof.com
Address
DESCRIPTION OF WORK
TOTAL SQUARES of
27
the entire scope of work:
Project Value (contract
6210
value or cost of ALL
i f
materials and labor)
.v
Are you re -decking the
No
roof?
Is the permit for a flat
Pitched roof (2:12 pitch or greater)
roof, pitched roof, or
50
both? (check all that
apply)
What is the specific pitch 5:12
of the PITCHED roof?
How many squares are 27
part of the PITCHED
roof?
Describe the roofing O/C Duration
materials for the
PITCHED roof:
Type of material for the Asphalt
PITCHED roof:
Provide any additional house
detail here on the
description of work. (Is
this for a house or
garage? Etc)
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
51
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.
Name of Applicant John Quante
Email not displaying correctly? View it in your browser.
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City of Wheat Ridge
Residential Mechanic PERMIT - 111362
PERMIT NO: 111362 ISSUED: 11/04/2011
JOB ADDRESS: 3505 FENTON ST EXPIRES: 11/03/2012
DESCRIPTION: Install 100,000 btu furnace
* ** CONTACTS * **
owner 303/420 -5918 Greg Glennon
sub 303/423 -7905 Timothy Bartels 01 -7674 B & B Heating & A/C
** PARCEL INFO
**
ZONE CODE:
UA
USE:
UA
SUBDIVISION:
0458
BLOCK /LOT #:
0/ -
** FEE SUMMARY ** ESTIMATED PROJECT VALUATION: 1,800.00
FEES
Permit Fee 40.00
Total Valuation .00 1
Use Tax 32.40
** TOTAL ** 72.40
Conditions:
Work shall comply with 2006 IRC & 2005 NEC. Per IRC Sec. R313, smoke detectors
are required to be installed in every sleeping room, in hallways outside of
sleeping rooms, and on every level of the structure. Carbon Monoxide detectors
are required to be installed within fifteen(15) feet outside the entrance to
each sleeping room. Subject to field inspection.
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 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 toe 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 in ection.
Sig r1t hi of Building Offical Date
IN N REQUEST L INE: (303)234 -5933 BUILDING OFFICE: (303)235 -2855
MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
i. - m:Nikki To: Building & Inspection Services (13032378929)
10:47 11/04/11 GMT -07 Pg 02 -02
City cal
W heat cube
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: fcIksrot,5 5roqqG�r
Property Owner (please print):
Mailing Address: (if different than property address)
Address:
City, State, Zip
Date:
Plan #
Permit # l ��
Phone:
Contractor: ��N� p[1Q- �1�h1bCTlibfJttJ(J
Contractors City License #: Q n ((,4 Phone: sts - +Zsz — — {y
Sub Contractors .
Electrical: Plumbing: Mechanical:
City License # City License # City License #
Description of work
contract Value:
Review Fee (due at time of submittal):
Squares BTU's Gallons_ Amps Sq Ft. $
OWNERICONTRACTOR SIGNATURE OR UNDERSTANDING AND AGREEMENT
I hereby certify that the setback distances proposedby this permit application are accurate and do not violate applicable ordinances,
Riles or regulations of the City of Wheat Ridge or covenants, easements or restrictions of record; that all measurements shown and
allegations made arc accurate: that 1 have read and agree to abide byall conditions printed on this application and that I assume full
responsibility for compliance wide 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 owmcr of the property to perfom the described work
and am also authorized by the le owne of any entity includedon this application to list that entity on this application.
CIRCLE ONE:
-I PRINT NANIE: bonr
(AUTHORIZED REPRESENTATIVE) of
h
INSPECTION RECORD
. Occupancy /Type
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.
INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS JOB
FOUNDATION INSPECTIONS
DATE -
INSPECTOR
INITIALS
COMMENTS:
Footings /Caissons
Stemwall / (GEG) Concrete
Encased Ground
-
Reinforcing. or Monolithic
Weatherproof/ French Drain
Sewer Service Lines
-
-
Water Service Lines
INSPECTIONS: FOR PLANNING R ZONING, FIRE AND PUBLIC WORKS SHOULD
BE CALLED AT LEAST ONE WEEK PRIOR. TO FINAL INSPECTIONS.
CONCRETE SLAB FLOOR
Electrical (Underground)
Plumbing (Underground)
Heating (Underground)
ROUGHS
Sheathing
Lath / Wall tie
Mid -Roof
Electrical Service -
Rough Electric
Rough Plumbing
Gas Piping
Mechanical
f
OCCUPANCY NOT PERMITTED UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED
In
PROTECT THIS CARD FROM THE WEATHER
F_
Far,
CRETE UNTIL A
FINALS
rianwiy
Insulation
Drywall Screw
f
OCCUPANCY NOT PERMITTED UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED
In
PROTECT THIS CARD FROM THE WEATHER
F_
Far,
CRETE UNTIL A
FINALS
Electrical
Plumbing
Mechanical
Roof
Building Final
Fire Department
-
-
R.O.W & Drainage
INSPECTIONS: FOR PLANNING R ZONING, FIRE AND PUBLIC 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.
£ ♦ 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: 35o.5' s 7
Permit Number: rE l35✓O
A AQP,-xjLo
❑ No one available for inspection: Time i; A tb
Re- Inspection required: Yes,
"When corrections have been made, calf for r inspection at 303 -234 -5933
Date: z is 114 Inspecto
DO NOT REMOVE THIS NOTICE
♦ 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: 1 Awl
Job Address: 3SoS si
Permit Number: /,9
❑ No one available for inspection: Time / 43 <Z&VPM
Re- Inspection required: Ye No
When corrections have been made, call for re inspection at 303 - 234 - 5933
Date: " as2 is Inspector: r
DO NOT REMOVE THIS NOTICE
_
♦ 4 4 , CITY OF WHEAT RIDGE
�V, Building Inspection Division
(303) 234 -5933 Inspection line
(303) 235 -2855 Office • (303) 237 -8929 Fax
INSPECTION NOTICE
Inspection Type: �= :n�siG A%wo '
Job Address: 3S05' 0 57
Permit Number: A l p / 3Yd
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❑ No one available for inspection: Time PM
Re- Inspection required: � No
When corrections have been made, calf for re at 303 - 234 - 5933
Date: Inspecto
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: f %h/A Anof
Job Address: .?SoS" /' Iy7®N ST
Per mit Number: iRIYY77
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❑ No one available for inspection: Time dl 'sa I I/PJVt
Re- Inspection required: es No
* When corrections have been made, call for re inspection at 303
Date: /a Inspector: r
DO NOT REMOVE THIS NOTICE
A City of Wheat Ridge
•
PERMIT NO:
101340
ISSUED:
05/25/2010
JOB 'ADDRESS'.'.
3505 FENTON ST
EXPIRES:
11/21/2010
DESCRIPTION:
Reroof 43 sqs with
25 yr OwensCorning shingles
BLOCK/LOT#: 0/
CONTACTS
owner 303/45G-5577
sub 7G3/427-2007
Greg Glenrion
Ty Adams
09-0128 Patriot Service Network, Inc.
PARCEL INFO
ZONE CODE; UA F
USE: UA
SUBDIVISION: 0458
BLOCK/LOT#: 0/
R
X" FEE SUMMARY
ESTIMATED
PROJECT VALUATION: 14,850.00
FEES
Permit Fee
326.70
Total Valuation
.00
)kV )I NNq
Use Tax
267.30
TOTAL
594.00
1p,
Cit f
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eat
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9
DEVELOPMENT
Building & Inspection Services Division
7500 W. 29" Ave., Wheat Ridge, CO 80033
Date:
Plan #
Permit # I 1�4 Wl)
Office: 303 -235 -2855 * Fax: 303 - 237 -8929
Inspection Line: 303 - 234 -5933
Building Permit Application
Property Adcli!ess: �.5 �en�o n «'C.
Property Owner (please print): � �,� n Phone:(--b3l11S(. -35t-)>7
Mailing Address: (if different than property address)
Address:
City, State, Zip;
Contractor: PCA O- `, rul ce 'Awo; K 1�
Contractors City License #: Phone: 1-- 7(3 -yaZ ! — r9 40
Sub Contras #ors:
Electrical: Plumbing: Mechanical:
City License # City License # City License #
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L eview 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 records 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 in cluded on this application to list that entity this application.
CIRCLEONE: (OWNER) (CONTRACTOR) . (AU THORIZED REPRESENTATIVE of(OWNER).(CONTRACTOR)
PRINT NAME: SIGNATURE: i , fns- ( DATE: 2.C)
` ,' �' ✓✓ DEPARTINENT� USI~ ONLY ✓'� f' ' � ��� � �
ZONING COMMENTS ✓ r s . ? A �: � ` "✓�� r:, dy✓ s,� '��� t✓ �r�.�, v. y "' �,ti%'
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/ BUILDING D�PARTyiENT COryJMEI�TS ,r r �� si ,� ..r r` "'�'✓ ,� v r ; ,, s i r . ✓
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Bldg Valuation: