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♦ 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: ;KV1S .e ms -
Permit Number: le,9ZYZ
❑ No one available for inspection: Time 3 AM ( M
Re- Inspection required: Yes No
When corrections have been made, call for re- inspection at 303234 -5933
Date: V25'1,0 Inspector:
DO NOT REMOVE THIS NOTICE
City of Wheat Ridge
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Date:
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COMMUNITY DEVELOPMENT
Plan #
Building & Inspection Services Division
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Permit # l
7500 W. 29
Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 " Fax: 303-237-8929
Inspection Line: 303-234-5933
Building Permit Application
~ropertyAddress
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Property Owner (please print): O%5 -2 ~C rLa -(eY-
Phone: E03 l/as~~i3o
Mailing Address: (if different than property address)
Address:
City, State, Zip:
Con6ac*: se k
Contractors City License M Phone:
Sub Cnntractors
Electrical: Plumbing:
Mechanical:
City License # City License #
City License #
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'crtntlon'~of work;,
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Contract Value:
$
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)g, (AUTHORIZED REPRESENTAH VE) o~f (OWNER) (CONTRACTO~R~)
PRINTNAME: SIGNATURE: eTEf3'OT' -X!< >
Bldg Valuation: $ f OY