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HomeMy WebLinkAbout11800 W. 44th Avenue7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-235-2857 Plan Inspection Line: 303-234-5933 Permit 0 Building Permit Application Property Address: Property Owner (please print): ?hyAm4 Phone: Mailing Address: (if different than property address) Address: M t) Yy*& Ft'ti -si City, State Zip: Wkm&v~ &2 gp~, 3 Contractor: Contractor License (No ( 3 P Phone: W-3 6Z5 - 5Z-73 Sub Contractors: Electrical City License Company: Exp. Date: Plumbing City License Company Exp. Date: Mechanical City License Company: Exp. Date: Use of space (description): Construction Value: $ 9, `19 Description of work: i1e (as calculated per the Building Valuation Data sheet) K COPZ & Cal,+ loge- Plan Review (due at time of submittal): $ . DLL6 'i- 7av li/tom Sq. Ft./L.Ft added: Squares 31 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. CIRLCEONE:: (OWNER) (CONTRACTOR) or PERSONAL REPRESENTATIVE of (OWNER) NTRA OR PRINT NAME: baVtn (yoc q- SIGNATURE: Date: ZONING~COMMENTS: Zoning: Reviewer: PUBLIC WORKS COMMENTS: Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: DEPARTMENT USE ONLY OCCUPANCY: FIRE DEPARTMENT:: ❑ approved w/ Comments ❑ disapproved ❑ no review required