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HomeMy WebLinkAbout3695 Allison CourtCity of Wheat Ridge Residential Roofing PERMIT - 201704991 111 PERMIT NO: 201704991 ISSUED: 07/27/2017 JOB ADDRESS: 3695 Allison CT EXPIRES: 07/27/2018 JOB DESCRIPTION: Residential Re -roof to install Malarkey Legacy asphalt shingles with 21 SQ House pitch 4/12 *** CONTACTS *** OWNER (720)935-4712 PRUITT/MAGNUSON SUB (303)425-7531 John Borfitz 019983 J & K Roofing Inc. *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2406 / BEL AIRE,HILLCREST HEIGHTS, ME BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 9,610.00 FEES Total Valuation 0.00 Use Tax 201.81 Permit Fee 204.30 ** TOTAL ** 406.11 *** 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) 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. Roof inspections for ROOFS OVER 6/12 PITCH: 3rd party inspection will be required, the 3rd party inspection report will be collected at final roof inspection performed by City of Wheat Ridge. If report is not available the final inspection will not be completed. City of Wheat Ridge Residential Roofing PERMIT - 201704991 PERMIT NO: 201704991 ISSUED: 07/27/2017 JOB ADDRESS: 3695 Allison CT EXPIRES: 07/27/2018 JOB DESCRIPTION: Residential Re -roof to install Malarkey Legacy asphalt shingles with 21 SQ House pitch 4/12 "b my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications, ap by thplicable building codes, and all applicable municipal codes, policies and procedures, and that I am the legal owner or have been authorized e legal owner of the roperty and am authorized to obtain this permit and perform the work described and approved in conjunction with this permit. I further attesthat I am le lly authorized to include all entities named within this document as parties to the work to be pert"ojrand that all work to bed is disclosed in this document and/or its' accompanying approved plans and specifications. Signature of OWNE or CMTRAC ircle one) Date 1. This permit was issued based on the i 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 maybe subject to a fee equal to one-half of the originalermitfee. 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, an 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 o ief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. I.7 C 4--`�/ - soil C . INSPECTION RECORD INSPECTION ONLINE FORM: http://www.ci.wheatridge.co.us/inspection INSPECTION REQUEST LINE: (303) 234-5933 Cancellations must be submitted via the online form before 8 a.m. the day of the inspection Occupancy/Type Inspections will not be performed unless this card is posted on the project site. **Request an inspection before 11:59 p.m. (midnight) to receive an inspection the following business day.** Inspector Must Sign ALL Spaces pertinent to this project Foundation Inspections Date Inspector Comments Initials Pier Concrete Encased Ground (CEG) _ Foundation / P.E. Letter Do Not Pour Concrete Prior 10 Approval Ur I ne ADove mspeciivns Underground/Slab Inspections Date Inspector Comments Initials Electrical Sewer Service _ Plumbing Do Not Cover Under round or Below/ln-Slab Work Prior To Approval Of The Above inspections Rough Inspections Date Inspector Initials Comments Wall Sheathing _ Mid -Roof, Lath / Wall Tie 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 inspections call 303-235-2846. For ROW and drainage inspections call 303-235-2861. For fire inspections contact the Fire Protection District for your project. ROW & Drainage / Public Works Dept. Floodplain Inspection (if applicable) Fire Inspection / Fire Protection Dist. Final Electrical 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 a Certificate of Occupancy is issued. Approval of the Final Building inspection does not constitute authorization of occupancy. *For low voltage permits — Please be sure that rough inspections are completed from the Fire District and electrical low voltage by the Building Division. Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued Protect This Card From The Weather w. City of Wheat Ridge Residential Roofing PERMIT - 201704991 PERMIT NO: 201704991 ISSUED: 07/27/2017 JOB ADDRESS: 3695 Allison CT EXPIRES: 07/27/2018 JOB DESCRIPTION: Residential Re -roof to install Malarkey Legacy asphalt shingles with 21 SQ House pitch 4/12 *** CONTACTS *** OWNER (720)935-4712 PRUITT/MAGNUSON SUB (303)425-7531 John Borfitz 019983 J & K Roofing Inc. *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2406 / BEL AIRE,HILLCREST HEIGHTS, ME BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 9,610.00 FEES Total Valuation 0.00 Use Tax 201.81 Permit Fee 204.30 ** TOTAL ** 406.11 PAID *** 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) 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. Roof inspections for ROOFS OVER 6/12 PITCH: 3rd party inspection will be required, the 3rd party inspection report will be collected at final roof inspection performed by City of Wheat Ridge. If report is not available the final inspection will not be completed. City of j9rWh6atR e - jig MUNiTY DEVELOl'i�4ENT Plea # Building& irispei®n Services Division Pei � 7500 W. 29"' Ave., Wheat Ridge, CO 80033 Office: 303-235-2555 * Fax: 303-237-8929 Inspection Line: 303-234-5933 Building Permit Application Property Address: Fip q 5 �0 I i -s t)v1 i i - Proper Owner (please printf.- � i N`"i,� S l� Phone: �� y� �� �� 2 -- Mailing ---Mailing address: (if different than property address) Address: City, State, Zip: Contractor: Contractors City License #: 1, O � Saa3� Contractor: Electrical: Plumbing: City License # City License # Description of work: Teftf o �� � Wil' � - WA 111 �-- - �i rt�h W 12- Squares BTU's Gailons Amps Phone: 6 (, 4 Zig' 1 e� 3 1 Mechanical: City License # Contract Value: S. Review Fee (due at time ofsubmittat): Sq Ft OWNERICONTRACTOR SIGNATURE OF UNDERSTANDING NDINC 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 Wfheat Ridge or covenants, easements orrestrictions of record; that all measurements shown and allegations made are accurate; that I have read and agree to abide by all conditions printed an 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 Iegal 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. CIRCLEONE. (OWNER (CONTRACTOR) or AUTHORIZED REPRESENTATIVE) of (©VINE P) (CONTRACTOR) A n PRINT NAME: DEPARTMENT USE ONLY ZONING COMMENTS: Zoning: Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: PUBLIC WORKS COMMENTS: Reviewer: f3s^.C[!PANCY: FIRE DEPARTMENT:: 11 approved wl comments 0 disapproved 0 no review required I Bldg Valuation: $ 1 Det%®ra to t?Y'clot],--�4 + T �,r L.a .d Ve)cam,(-1 D-ap-e-� a�f Skalc. '1 W"Viv LLC CONTRACT �s5 F_ .S�e, I 1 c �- J&K Roofing 3� CA BBB` 13000 W. 43rd Drive •Golden, CO 80403 issa-aop .' gM r v a �a C D Phone: 303-425-7531 • Fax: 303-425-1562 X000 7 www.jkroofing.com Representative 0�� Contact �Z� 2 7 Date Zq 20 Name �r �i R1 G�td��c� &h`'P te, _?Z0 �i Z. email SimaA Yl'20 coiv Address S(P 9 S (1 o M 01 City L')6A A y r Zip Pinnacol Assurance 303-361-4000 Workers Compensation Insurance Policy #4079290 LABOR AND MATERIAL SPECIFICATIONS TERMS AND CONDITIONS. PLEASE READ CAREFULLY: Recover roof with Ma /Color of shingles—Uta t�c L )ry% Yanufacturer's Warranty i M' tC L . t'y nl ear off (' © VA f stall Underlayment Y ouble all Eaves 1 C -e-- Re-Flash Re -Flash Chimney and/or Skylights New Valleys Int. -'Z.. L,-) c / place Ridge Ventilation �� z � C, k- ,eGalvanized Fasteners i�2 E Replace 3 Plumbing Jacks Paint roof stacks to match t Xnstall 2 iZ Z Metal Edging _ FJY\ T1, -:c ❑ Patio or Flat roof Year Warranty on labor J K Roofing to furnish all material and labor rmit: 2— Included NOT Included Clean-up debris and haul off all trash from roof Roll yard with magnetic roller Gutters cleaned of roofing debris ❑ Decking Repairs $ per ❑ Hidden Layers (tear off) $ per layer F)rcemns� T tn<,Ai, a -c (c (Policy Number) (Ca m n), ©1.1 -7-9 (adjustor) Cincinnati Specialty Underwriters 303-653-0023 General Liability Insurance t Policy #CS00061742 El Extra work t`.nt) R G to 3- 44 S ,fie>U�C 2S��'_AaV'1 If55 VLE f. e �yt Z --k - The property owner is is not using proceeds from property and casualty insurance policy. Deductible if applicable $� C1�? Per Colorado State Law CRS§6-22-105 which states; 100% the responsibility of the homeowner to pay this amount. J & K Roofing will not reimburse or promise to reimburse in whole or in part any amount of the deductible. Estimated Start Date `e- c / - TOTAL ESTIMATE $ WW I� I Q ALL PROPOSALS ARE SUBJECT TO MANAGEMENT APPROVAL J&K Representative Date Homeowner_ Dater j Homeowner Date 6 -&7-0 wongage Co) (Mortgage Loan Number) Expiration Date You have the right to recind this contract and obtain a full refund of any deposit within 72 hours after entering the contract. If you plan to use the proceeds from a property and casualty insurance policy to pay for the roofing work, you may rescind this contract within 72 hours after receiving written notice from your insurance carrier that your claim has been denied in whole or in part. However, J&K Roofing is entitled to retain payments or deposits to compensate for roofing work actually performed in a workmanlike manner consistent with standard roofing practices. PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION Dan Schultz From: no-reply@ci.wheatridge.co.us Sent: Wednesday, July 19, 2017 12:58 PM To: CommDev Permits Subject: Online Form Submittal: Residential Roofing Permit Application Categories: Gina 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. Is this application for a Yes residential roof? How many dwelling units Single Family Home are on the property? PROPERTY INFORMATION Property Address 3695 Allison Ct Property Owner Name Pruett/Magnuson Property Owner Phone Number Property Owner Email Address 720-935-4712 Field not completed. Do you have a signed Yes contract to reroof this property? It will need to be provided at the time of permit pick-up. CONTRACTOR INFORMATION Contractor Name J&K Roof'n Contractor's License 019983 Number (for the City of Wheat Ridge) Contractor Phone 303-425-7531 Number Contractor Email Address kathyv@jkroofing.com Retype Contractor Email kathyv@jkroofing.com Address DESCRIPTION OF WORK Are you re -decking the No roof? Description of Roofing Malarkey Legacy Material Select Type of Material: Asphalt If "Other" is selected Field not completed. above, describe here: How many squares of the 21 material selected above? Does any portion of the property include a flat roof? If yes, how many squares on the flat roof? No Field not completed. TOTAL SQUARES of all 21 roofing material for this project Provide additional detail House - pitch 4/12 here on the description of i work. (Is this for a house or garage? What is the roof pitch? Etc) Project Value (contract 9610 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 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 Kathy Vendegna Email not displaying correctly? View it in your browser. 3 30/ION SIHI-gAOW3hl ION 00 :aoloodsul ££65-b£Z-£o£ le uoiloadsui-aj jo{ ileo `apew uaaq aneq suoiloaajoo uaUM, cN spA :paainbaa uoiloodsul-aa Wd/�� JC quail :uoi}oadsui aol ajgejiene quo ON /�ShJ�/c%6-1 :aagwnN MwJGd 11 o/ 1114' I �/ :ssaippd qor :adA1 uoi}oadsul 331ION N01133dSNI xeJ 6069 -ZOO (000) - aa140 5582-300 (000) au/l uol;oadsul ££69-b£Z (£O£) uoisinia uoiloadsul 6uippe 3001a 1V3HM d0 A113 Al A i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTIONNOTICE 4410 Inspection Type: Job Address: G e, C Permit Number: ZV 17 w `) 9 ❑ No one available for inspection: Time ` VT /PM Re -Inspection required: Yes When corrections have been made, call forre-inspectionat 303-234- re5933 Date: �� f Inspector: /t DO NOT REMOVE THIS NOTICE INSPECTION RECORD Occupancvffype '!P - 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. i 6 IMWO INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS JOB FOUNDATION INSPECTIONS DATE '. INSPECTOR INITIALS COMMENTS: Footings /Caissons Stemwall / (CEG) Concrete Encased Ground Reinforcing or Monolithic Weatherproof/ French Drain Sewer Service Lines Water Service Lines POUR No CONCRETE UNTIL ABOVE HAS BEEN SIGNED CONCRETE SLAB FLOOR Electrical (Underground) Plumbing ;(Underground) Heating. (Underground) DO Not POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ROUGHS '. Sheathing Lath/ Wall ifie Mid Roof Electrical SRough Elec Rough Plum - Gas Piping: -Rough Mechanical .ABOVE INSPECTIONS TO BE SIGNED PRIOR TO PROCEEDING Framing Insulation Drywall Screw OCCUPANCY NOT PERMITTED UNTIL CERTIFICATE OF OCCUPANCY IS ISSUED PROTECT THIS CARD FROM THE WEATHER ♦ 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: l ,4z- Job Address: _ /,`�5 �✓✓ r c� ca -- - r Permit Number: /d 14 4 14 /add rzrit�c 441 t_rsC- ❑ No one available for inspection: Ime AM /PM Re- Inspection required: Yes o When corrections have been mad ,tali or 11 - inspection at 303 Date: inspector: l DO NOT REMOVE H NOTICE City of Wheat Ridge _� Residential Electric PERMIT - 101646.: k PERMIT NO: 101646: D ISSUED.: 06/29/2010 JOB ADDRESS: 3695 ALLISON CT EXPIRES: 12/26/2010 DESCRIPTION:: 150 amp service change IR ** *'CONTACTS * ** owner 303/424-8802 Dixie Longman rs, sub 303/979-1641 John McGrath 01 -9585 Over -all Electric Subject to field inspections. s� ** PARCEL INFO ** ZONE a CODE: UA USE: UA r: SUBDIVISION:.. 0567 BLOCK /LOT #: 0./ rK FEE SUMMARY ** ESTIMATED PROJECT VALUATION: ;1,750.00 FEES Permit Fee 82.16 Total Valuation .00 Use ._Tax 31.50 * *.TOTAL ** - :113.66 Conditions: C Must comply w/ 2003 'IRC & 2005 NEC.: Subject to field inspections. WHEAT City of Wheat Ridge Building Division ° 7500 W. 29 Ave., Wheat Ridge, CO 80033 v m Office: 303 - 235 -2855 . Fax: 303- 235 -2857 ° o Inspection Line: 303 - 234 -5933 O tORPO Date: Plan #: Permit A. Building Permit Application Property Address: Property Owner (please print) 1, Mayl Phone: s Mailing Address: (if different than property address) Sub Contractors: Electrical City License #:019 585 Company: Plumbing City License #: Mechanical City License #: Company Company: Exp. Date: Exp. Date: Exp. Date: Approval: Approval: Approval: Use of space (description): Construction Value: $- - A 500, 0( Description of work: (as calculated per the Building valuation Data sheet) caj�—Yl v Plan Review (due at time of submittal): $__ Sq. Ft. /L.Ft added: Squares BTU's Gallons Amps 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 the Wheat Ridge Building Code (I.B.C) and all other applicable Wheat Ridge Ordinances, for work under this permit. Plans subject to field Inspection. CIRLCE ONE:: W(NnyER) (CONTRACTOR), or PI �� PRINT NAME: U`t) C J i Y „ ( ZONING COMMENTS: Zoning: Reviewer: PUBLIC WORKS COMMENTS: Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: ONLY (CONTRATOR) I Dat . OCCUPANCY: FIRE DEPARTMENT:: ❑ approved w/ Comments ❑ disapproved ❑ no review required I Bldg Valuation: Contractor License #: i la Phone: 9- G 1. I�O `-°l, INSPECTION RECORD Occupancy /Type r, - 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. 3 V1 � _t 5�11 INSPECTOR MUST SIGN ALL SPAC S F TO THIS JOB F INSPECTOR FOUNDATION INSPECTIONS DAFE COMMENTS: INITIALS Footings /Caissons z ; Stemwall / (CEG) Concrete Encased Ground ,r Reinforcin or Mon olithic Weatherproof/ French Drain Sewer :Se rvl�e Lines Water Service Lines f POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED CONCRETE SLAB FLOOR Electrical (Underground) Plumbing (Underground) Heating (Underground) ; :DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ROUGHS Sheathing Lath / Wall tie Rough Electric Rough' Plumbing Gas Piping _ i CITY OF WHEAT RIDGE Building Inspection Division r (303) 234 -5933 Inspection line (303) 235 -2855 Office • (303) 237 -8929 Fax INSPECTION NOTICE Inspection Type: M/ / X,, 1 Cj r te. Job Address: Permit Number: a ❑ No one available for inspection: Time AM /PM Re- Inspection required: Yes(�No- ,I When corrections have been made, call fd re -inspe ion at 303- 234 -5933 r Date: .6 Inspector: DO NOT REMOVE THIS NOTICE 06/22/2010 1:2 /19/2010 I City of Y v �:E'-c` t Date: COMMUNITY DEVELOPMENT Plan # Building & Inspection Services Division Permit# to f 7500 W. 29 Ave., Wheat Ridge, CO 80033 b Office: 303 - 235 -2855 * Fax: 303 - 237 -8929 Inspection Line: 303 - 234 -5933 Building Permit Application PropertyAddibts' 31�I om / GL /J 6/J T_ / C Property Owner (please print) /v` t�OR60 C On)6.KrF Phone: Mailing Address: (if different than property address) Address: City, State, Zip: lruintfactoe t c�TA.t ��[nK8 //�F/ Contractors City License #: 01 72 0 J Phone: Stb:Csrgfractors€ ' Electrical: Plumbing: Mechanical: City License # City License # City License # bescrintio - w ki 1 4 (2 Wlj l� - 14 , A / z z Z • X 7 11 . Contract Value: rr�� 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) or (AUTIfORIZED REPRESENTATIVE) of (OWNER) ONTRACTOR PRINT NAME: SIGNATUR DATE: — Zz�JO Bldg Valuation: $