HomeMy WebLinkAbout4160 Ingalls StreetA City of Wheat Ridge
E -Res. Furnace Replacement PERMIT - 201901089
PERMIT NO:
201901089
ISSUED:
05/29/2019
JOB ADDRESS:
4160 Ingalls St
EXPIRES:
05/28/2020
JOB DESCRIPTION:
Furnace replacement,
70k BTUs and 80% efficiency in
crawl space.
*** CONTACTS ***
OWNER (303)474-5396
PADILLA JOSE INES
SUB (303)766-7500
Jeff Belk
021818 Plumbline
Services
*** PARCEL INFO.***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2405 / BARTHS,-COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 4,845.00
FEES
Furnace Replacement 40.00
Total Valuation 0.00
Use Tax 101.75
** TOTAL ** 141.75
*** COMMENTS ***
*** CONDITIONS ***
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.
Work shall comply with 2012 IRC & 2017 NEC. Per IRC Sec. R314, smoke detectors are required
to be installed in every sleeping room, in hallways outside of sleeping rooms, and on every
level of the structure.
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 pe in I further attest that I am legally authorized to include all entities named within this document as partes 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 Flans 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 originalpenmt 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 androcedures 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
apple code or any4inance or regulation of this jurisdiction. Approval of work is subject to field inspection.
Signature of Chief Building Official Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
Dina Kemp
From: no-reply@ci.wheatridge.co.us
Sent: Wednesday, May 29, 2019 8:31 AM
To: CommDev Permits
Subject: Online Form Submittal: Residential Furnace/Boiler Replacement Permit Application
Residential Furnace/Boiler Replacement Permit Application
This application is exclusively for RESIDENTIAL REPLACEMENT FURNACE or
BOILER - LIKE FOR LIKE ONLY.
YOU MUST ATTACH A VALID CREDIT CARD AUTHORIZATION 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.
Is this application for a Yes
replacement residential
furnace or boiler like for
like?
PROPERTY INFORMATION
Property Address
Property Owner Name
Property Owner Phone
Number (enter WITH
dashes, eg 303-123-4567)
Property Owner Email
Address
Attach Credit Card
Authorization Form -
**DO NOT ATTACHED
RANDOM FORMS**
4160 Ingalls ST
Jose Padilla
303-474-5396
$'/w- r7��
permits@plumblineservices.com
20190529082207.pdf
CONTRACTOR INFORMATION
Contractor Business Plumbline Services
Name
I
Contractor's License 021818
Number (This is a 5 or 6
digit number for the City
of Wheat Ridge)
Contractor Phone 303-766-7500
Number (enter WITH
dashes, eg 303-123-4567)
Contractor Email Address permits@plumblineservices.com
Retype Contractor Email permits@plumblineservices.com
Address
DESCRIPTION OF WORK
What type of unit is being Furnace
installed?
Number of BTUs 70
What is the efficiency 80
(%) of the unit?
Is the unit GAS or gas
ELECTRIC?
Where is the furnace or crawispace
boiler located (for
example, basement,
crawlspace, etc)?
Project Value (contract 4845
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
z
has been issued and
posted on the property.
I certify that I have been Yes
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 Carolyn Larson
Permit
Email not displaying correctly? View it in your browser.
i CITY OF WHEAT RIDGE
_:�9rBuilding Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: 9 6 1
Job Address: t-( 6 O� l 1 S s
Permit Number: 9 617 D 1 qV 7
MIN ' IM, MI ► t.
❑ No one available for inspection: Timeq- AM/PM
Re -Inspection required: Yes
When corrections have been made, call for re -inspection at 303-234-5933
Date: !/ a 7 Inspector:
DO NOT REMOVE THIS NOTICE
-)
J INS C O N RECORD °ccurancv/Twe
,, .� -
INSPECTION REQUEST LINE: (303) 234-5933
Inspections will not be performed unless this card is posted on the project site.
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
Initials Comments
Pier
Concrete Encased Ground (CEG)
Foundation / P.E. Letter
o Not Pour Concrete Prior To A proval Of The Above Inspections
Undergr��—
nspections Date Inspector
Initials Comments
Electrical
Sewer Service
Plumbing
Do Not Cover Underground or Below/In-Slab Work Prior To Approval Of The Above Inspections
Rough Inspections Date Inspector
Initials Comments
Wall Sheathing
Mid -Roof
Lath / Wall Tie c
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
ROW & Drainage / Public Works Dept.
Floodplain
Inspection (if applicable)
inspections call 303-235-2846. For ROW and drainage
inspections call 303-235-2861. For fire inspections
Fire Inspection /Fire Protection Dist.
Final Electrical
contact the Fire Protection District for your project.
Final Plumbing
Final Mechanical
Roof
Final Window/Doors
Final Building
NOTE: All items must be completed and approved by Planning, Public Works, Fire and Building before Certificate
Occupancy
of a
is issued. Approval of the Final Building inspection does not constitute authorization
of occupancy.
*For low voltage permits —Please be sure that rough inspections ara cmm��atcrl frnn, +ho r.. 1,: ._: . __� _,
�r aluuu'u'I 'YLJIv15Fun, ...� - - --- - `^••" 1wa1 IVVV VIIILdLJ.0
For notification of your assigned inspection time window please email insptimerequestCa)ci.wheatridge.co.us by 8:00 A.M.
the day of the inspection with the property address in the subject line of the email. Time windows are assigned based on
inspection routing.
Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued
Protect This Card From The Weather
City of Wheat Ridge
Residential Roofing PERMIT - 201701947
c,RMIT N0: 201701947
ISSUED: 06/13/2017
OB ADDRESS: 4160 Ingalls ST
EXPIRES: 06/13/2018
OB DESCRIPTION: House Roof. Owens Corning Duration Storm - Asphalt Shingle on 4/12 pitch.
Mulehide SA modified bitumen will be installed on 1/12 section of the roof;
Owens Corning Duration Storm - Asphalt Shingle. Mulehide SA modified
bitumen will be installed on 1/12 section of the roof - 22 squares
** CONTACTS ***
,WNER (303)981-0669 PADILLA JOSE INES
170217 Rocky Mountain Enterprises LLC
IUB (720)663-7766 Darrin Azar
** PARCEL INFO *** USE: UA / Unassigned
;ONE CODE: UA / Unassigned
iUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 /
** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 6,000.00
FEES
Potal Valuation 0.00
Tse Tax 126.00
Permit Fee 140.90
** TOTAL ** 266.90
*** 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 spaced
or board sheathing with ANY gap exceeding Al/a-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 manufacturer&€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: Ik O F
Job Address: 1-1160 .Z Ale -4 Ls
Permit Number: "Z0/ `% O
L�Mo one available for insp�.ction: Time f 1 AM/PM
Re -Inspection required :YeDsNo
When corrections have been made, call for re -:]:7303-234-5933
Date: I / Inspector:G
DO NOT REMOVE T S NOTICE
City of Wheat Ridge
Residential Roofing PERMIT - 201701947
PERMIT NO: 201701947 ISSUED: 06/13/2017
JOB ADDRESS: 4160 Ingalls ST EXPIRES: 06/13/2018
JOB DESCRIPTION: House Roof. Owens Corning Duration Storm - Asphalt Shingle on 4/12 pitch.
Mulehide SA modified bitumen will be installed on 1/12 section of the roof;
Owens Corning Duration Storm - Asphalt Shingle. Mulehide SA modified
bitumen will be installed on 1/12 section of the roof - 22 squares
*** CONTACTS ***
OWNER (303)981-0669 PADILLA JOSE INES
SUB (720)663-7766 Darrin Azar 170217 Rocky Mountain Enterprises LLC
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 6,000.00
FEES
Total Valuation 0.00
Use Tax 126.00
Permit Fee 140.90
** TOTAL ** 266.90
*** 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 spaced
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.
City of Wheat Ridge
Residential Roofing PERMIT - 201701947
PERMIT NO: 201701947 ISSUED: 06/13/2017
JOB ADDRESS: 4160 Ingalls ST EXPIRES: 06/13/2018
JOB DESCRIPTION: House Roof. Owens Corning Duration Storm - Asphalt Shingle on 4/12 pitch.
Mulehide SA modified bitumen will be installed on 1/12 section of the roof;
Owens Corning Duration Storm - Asphalt Shingle. Mulehide SA modified
bitumen will be installed on 1/12 section of the roof - 22 squares
I, by. my signature, do hereby attt that the work to be performed shall comply with all accompanying approved plans and specifications,
applicable building co and a I applicable municipal codes, policies and procedures, and that I am the legal owner or have been authorized
by the legal owner of the op "; and am authorized to obtain this permit and perform the work described and approved in conjunction with
thispermit. I further attest t m le ally authorized to include alI entities named within this document as parties to the work to be
performed and that all A,drk t6 per is disclosed in this document and/or its' accompanying approved plans and specifications.
Signature of; OWNER'I or tONTRAC(Circle one) Date
I . This permit was issued based on the info ation 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 androcedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of
ff
the Chief Building Official and is not guaranteed.
4, No work of an 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 sh,_ of proceed or conceal work without written approval of such work from the Building and Inspection Services
Division. tr
6. The issuance or gra ermi s o e c nstrued to be a permit for, or an approval of, any violation of any provision of any
applicable code o t or r his jurisdiction. Approval of work is subject to field inspection.
Signature of Chief Building Official Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
Inspection time requests will be accepted by email only. Please email requests to insptimerequest@ci.wheatridge.co.us
between 7:30am and 8:00am, the morning of the inspection. Please put the address of the inspection in the subject line.
Kimberly Cook
ao1 1D)Cfli
From: no-reply@ci.wheatridge.co.us
Sent: Thursday, June 8, 2017 11:21 AM
To: Permits CommDev
Subject: Online Form Submittal: Residential Roofing Permit Application
Residential Roofing Permit Application
i -
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. 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. Permits are currently being
processed within 24-48 hours, subject to change based on volume.
For all other requests:
Homeowners wishing to obtain a roofing permit must apply for the permit in person
at City Hall. Existing permits that require amendments (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.
PROPERTY INFORMATION
Property Address
Property Owner Name
Property Owner Phone
Number
Property Owner Email
Address
Do you have a signed
contract to reroof this
property?
It will need to be
provided at the time of
permit pick-up.
4160 Ingalls St Wheat Ridge, CO 80033
Jose Padilla
3039810669
Field not completed.
Yes
CONTRACTOR INFORMATION
Contractor Name Rocky Mountain Enterprises
Contractor's License 170217
Number (for the City of
Wheat Ridge)
Contractor Phone 720-799-7560
Number
Contractor Email Address joe@rmeroofing.com
(permit pick-up
instructions will be sent
to this email)
DESCRIPTION OF WORK
Is this application for a Yes
new permit for a
residential roof?
Are you re -decking the No
roof?
Description of Roofing Owens Corning Duration Storm - Asphalt Shingle. Mulehide SA
Material modified bitumen will be installed on 1/12 section of the roof.
How many squares of 22 SQ
material?
Provide additional detail House Roof. Owens Corning Duration Storm - Asphalt Shingle
here on the description of on 4/12 pitch. Mulehide SA modified bitumen will be installed
work. (Is this for a house on 1/12 section of the roof.
or garage? What is the
roof pitch? Etc)
Project Value (contract 6000
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 this Yes
application is NOT a
2
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
submit this application
and to perform the work
described above.
Name of Applicant Darrin Azar
Email not displaying correctly? View it in your browser.
ROCKY MOUNTAIN ENTERPRISES
ROOFING - SIDING - GUTTERS
PAINT - DOORS - WINDOWS - HVAC
(720) 663-7766 ti
300 E Miller Court #1571 13131
Castle Rock, CO 80104 ON
Customer Information
Insurance Information
Property Owner is x_f is not intending to make payments from the
proceeds of a property and casualty insurance policy.
Project Manager:
2A.A Q -0-1p
Insurance Company:
I
Policy Number:
ip
Claim Number:
16VA-9�1 4Z-,��=
Adjuster Name & Phone:
Date of Loss:
�' ��
CONTRACTOR AGREEMENT
Name:
,b!&
Phone:
c -Oto
Address: � ` S
o3cj
ROCKY MOUNTAIN ENTERPRISES
Wednesday, 141h 2017
RE: Permit Authorization
ATTN: Building Department, Wheat Ridge
To Whom it may concerns,
Mike Stookey is authorized to pull permits for the Rocky Mountain Enterprises for the City of Wheat
Ridge. If you have any questions or concerns, please let me know, thanks
Cordially,
Z�'aAAZ v ,4ya, ,
Darrin Azar
Owner
Rocky Mountain Enterprises
720-663-7766 Cell
303-953-2636 Office
Darrin@rmeroofing.com
Rocky Mountain Enterprises
14 Inverness Dr. Suite G210
Englewood, CO 80112
303-953-2636 Office
RMERoofing. com
' A City of Wheat Ridge
Residential Roofing PERMIT - 094167 `
PERMIT NO: 094167 ISSUED: 11/19/2009
JOB ADDRESS: 4160 INGALLS ST EXPIRES: 05/18/2010
DESCRIPTION:-Reroof sqs
CONTACTS
owner 303/28G-3525 Jose Padilla
sub 303/443-7931 02-1976 Mathieson Roofing Service Corp
**iPARCEL INFO
ZONE `CODE: UA USE: UA
SUBDIVISION:' 0392. BLOCK/LOT#: 0/
FEE SUMMARY ESTIMATED PROJECT VALUATION: 5,344.00
FEES
Permit Fee 162.90
Total Valuation 00
Use Tax 96.19
TOTAL .u,
259.09
Comments:
Conditions:
6 nail installation& mid roof inspection required. Board sheathing spaced more
thanes 1/2 of an inch apart requires plywood overlay on entire roof. Ice and
water shield.. required from eave edge to 2' inside exterior walls.
***Contractor/Property owner shall provide ladder(s) secured in place for
inpsections.'.
>ubject to field inspection;-.
I hereby certifythat 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
,pon
application and that I assume full pe< sibility for compliance with the Wheat Ridge Building Code (I. B.C) and all other
ap l e eat Ridge Ordrna or. work under this permit. ans subject to field inspection.
Signature-of contractor/o/w/ner ''date
This permit was issued in accordance with the provisions set forth in your application and is subject to the laws of the
state of Colorado and to the Zoning' Regulations and Building Codes of Wheat Ridge, Colorado or any other applicable
ordinances of the City.
This permit shall expire `.180 days from the issue date. Requests for an extension must be received prior to expiration
date. An extension may be granted at the discretion of the Building Official.
If this permit expires, a new permit may be acquired for -a fee of one-half the amount normally required, provided no
changes have been or will be made in the original plans and specifications and any suspension or abandonment has not
exceeded one (1) year. If changes have been or if suspension or abandonment exceeds one (1) year, full fees r. shall
be paid for anew permit','
No work of any. manner skull be done that will change the natural flow of water causing a'. drainage problem.
Contractor shall notify the Building Inspector twenty-four (24) hours in advance for all inspections and shall receive
written approval on inspection card before proceeding with successive phases of the job.
Thee: issuance of a permit or the approval of drawings and.. specifications shall not be construed to be a permitfor, nor
an approval o any violation of the provisions of the building codes or any other ordinance, law,. rule or regulation.
A11 -:p n ev is subject to field,. inspections.
ignatu of ref'8mldmg Official date
NSPCTION REQUEST LINE: (303)234-5933 BUILDING. OFFICE:.. (303)235-2855
EQUESTS MUST:: BE MADE BY 3PM': ANY BUSINESS `DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
a "ter City of Wheat Ridge Bulldingl Division
m 7500 W. 29In Ave., Wheat Ridge, CO 80033
Office: 303-235-2866 " Fax: 303-235-2857
di oR a° inspection Line: 303-234-5933
Building Permit Application
Property Address: 41160 T(1j4 /p k
Property Owner (please print):
Contractor:
Contractor License Phone:
6.,Ub'~okltad6t01~:. .
Electrical City License Plumbing City License fP Mechanical City License
Company: Company Company:
Exp. Date: Exp. Date: Exp. Date:
Approval: Approval: Approval:
Use of space (description): construction Value; S
Description of works ® (as aaiculated per the BuNdirw varuation hats sheet)
Ave- ,f Plan Review (due at time of subm)tlaq: $
Lv t A 5 ow 1 v ccpee crlit
Sq. Ft./L.Ft added: qha r BTU's Gallons Amps
at the setbacA distances PrOposed by this permit application are accurate, and do not violate applicable ordinances,
is of the city of Wheat wage or covenants, easements or restnollorts of record; that atl measurements shown, and
are accurate; That I have 'read and awe to ablde all conditions printed on this application and that I assume full
compliance with the YAheat.Rldoe Building Code (Ibyy .B.C) and all other applicable Wheat Ridge Ordinances, for work
CIRLCE ONE:: (OWNER) CONTRACTOR) r PE ONAL REPRESENTATIVE of (OWNER) (CONTRATOR)
PRINT NAME: 1 SIGNATURE: Date:
Date:
Plan
Perma t 1 1
Mailing Address: (if different than property address)