HomeMy WebLinkAbout3815-3817 Parfet StreetCity of Wheat Ridge
E -Res. Furnace Replacement PERMIT - 202002685
PERMIT NO: 202002685 ISSUED: 12/29/2020
JOB ADDRESS: 3817 Parfet St EXPIRES: 12/29/2021
JOB DESCRIPTION: Installing 66k BTU, 80% efficiency gas furnace in crawlspace.
*** CONTACTS ***
OWNER ( 3 0 3) 898-8498 COOK J I M
SUB (303)421-3572 WILLIAM BURAS 017865 LAKESIDE HEATING & A/C
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2403 / APPLEWOOD VILLAGES, PROSPECT V BLOCK/LOT#: /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 11900.00
FEES
Total Valuation 0.00
Use Tax 39.90
Permit Fee 74.10
** TOTAL ** 114.00
*** 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 2018 IRC & 2020 NEC. Smoke alarms shall comply with 2018 IRC Section
134. Interior alterations, repairs, fuel -fired appliance replacements, or additions, any of
which require a building permit, occurs or where one or more rooms lawfully used for
sleeping purposes shall have an operational carbon monoxide alarm installed within fifteen
feet of the entrance to each room lawfully used for sleeping purposes.
1* � � i City of Wheat Ridge
E -Res. Furnace Replacement PERMIT - 202002685
PERMIT NO: 202002685 ISSUED: 12/29/2020
JOB ADDRESS: 3817 Parfet St EXPIRES: 12/29/2021
JOB DESCRIPTION: Installing 66k BTU, 80% efficiency gas furnace in crawlspace.
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�permrt. I further attest that I am leg ally 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 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 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 requ�ired
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, anviolation 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 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: Tuesday, December 29, 2020 7:45 AM
To: CommDev Permits
Subject: Online Form Submittal: Furnace/Boiler Replacement Permit Application
Categories: Dina
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
Is this Residential or Residential
Commercial?
Property Address 3817 Parfet St.
Property Owner Name Jim Cook
Property Owner Phone
Number (enter WITH
dashes, eg 303-123-4567)
Property Owner Email
Address
Attach City of Wheat
Ridge Electronic Payment
Form - **DO NOT
ATTACH A PICTURE
OF A CREDIT CARD*
Field not completed.
WR Credit Card Authorization Form .odf
1
CONTRACTOR INFORMATION
Contractor Business Lakeside Heating & AC
Name
Contractor's License 017865
Number (This is a 5 or 6
digit number for the City
of Wheat Ridge)
Contractor Phone 303-421-3572
Number (enter WITH
dashes, eg 303-123-4567)
Contractor Email Address becky.b@lakesideheating.com
Retype Contractor Email
becky.b@lakesideheating.com
Address
DESCRIPTION OF WORK
What type ofunit is being
Furnace
installed?
Number of BTUs
66000
What is the efficiency
80
(%) of the unit?
Is the unit GAS or
gas
ELECTRIC?
Where is the furnace or
crawlspace
boiler located (for
example, basement,
crawlspace, etc)?
Project Value (contract
1900
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
N
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 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 Rebecca Buras
Permit
Email not displaying correctly? View it in your browser.
City of Wheat Ridge
E -Res. Furnace Replacement PERMIT - 202002684
PERMIT NO: 202002684 ISSUED: 12/29/2020
JOB ADDRESS: 3815 Parfet St EXPIRES: 12/29/2021
JOB DESCRIPTION: Installing 66k BTU gas furnace in crawl space.
*** CONTACTS ***
OWNER ( 3 0 3) 898-8498 COOK J I M
SUB (303)421-3572 WILLIAM BURAS 017865 LAKESIDE HEATING & A/C
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2403 / APPLEWOOD VILLAGES, PROSPECT V BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 11900.00
FEES
Furnace Replacement 40.00
Total Valuation 0.00
Use Tax 39.90
** TOTAL ** 79.90
*** 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 2018 IRC & 2020 NEC. Smoke alarms shall comply with 2018 IRC Section
134. Interior alterations, repairs, fuel -fired appliance replacements, or additions, any of
which require a building permit, occurs or where one or more rooms lawfully used for
sleeping purposes shall have an operational carbon monoxide alarm installed within fifteen
feet of the entrance to each room lawfully used for sleeping purposes.
1* � 4 41'
PERMIT NO:
JOB ADDRESS:
JOB DESCRIPTION:
City of Wheat Ridge
E -Res. Furnace Replacement PERMIT - 202002684
202002684
3815 Parfet St
ISSUED: 12/29/2020
EXPIRES: 12/29/2021
Installing 66k BTU gas furnace in crawl space.
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 permrt. I further attest that I am leg ally 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 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 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 requ�ired
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, anviolation 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 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: Tuesday, December 29, 2020 7:42 AM
To: CommDev Permits
Subject: Online Form Submittal: Furnace/Boiler Replacement Permit Application
Categories: Dina
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
Is this Residential or Residential
Commercial?
Property Address 3815 Parfet St
Property Owner Name Jim Cook
Property Owner Phone
Number (enter WITH
dashes, eg 303-123-4567)
Property Owner Email
Address
Attach City of Wheat
Ridge Electronic Payment
Form - **DO NOT
ATTACH A PICTURE
OF A CREDIT CARD*
Field not completed.
WR Credit Card Authorization Form .odf
1
CONTRACTOR INFORMATION
Contractor Business Lakeside Heating & AC
Name
Contractor's License 017865
Number (This is a 5 or 6
digit number for the City
of Wheat Ridge)
Contractor Phone 303-421-3572
Number (enter WITH
dashes, eg 303-123-4567)
Contractor Email Address becky.b@lakesideheating.com
Retype Contractor Email
becky.b@lakesideheating.com
Address
DESCRIPTION OF WORK
What type ofunit is being
Furnace
installed?
Number of BTUs
66000
What is the efficiency
80
(%) of the unit?
Is the unit GAS or
gas
ELECTRIC?
Where is the furnace or
crawl space
boiler located (for
example, basement,
crawlspace, etc)?
Project Value (contract
1900
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
N
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 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 Rebecca Buras
Permit
Email not displaying correctly? View it in your browser.
d City of Wheat Ridge
Residential Plumbing PERMIT - 201708417
PERMIT NO: 201708417 ISSUED: 10/18/2017
JOB ADDRESS: 3817 Parfet ST EXPIRES: 10/18/2018
JOB DESCRIPTION: Permit to install a residential gas water heater: 40 gallons, 40K BTU
*** CONTACTS ***
OWNER (303)898-8498 JIM COOK
SUB (303)757-5661 Larry D. Bell 017174 Bell Plumbing & Heating
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2403 / APPLEWOOD VILLAGES, PROSPECT V BLOCK/LOT#: /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 1,700.00
FEES
Hot Water Heater 40.00
Total Valuation 0.00
Use Tax 35.70
** TOTAL ** 75.70
*** COMMENTS ***
*** CONDITIONS ***
All work shall comply 2012 International Codes, 2014 NEC (if applicable), and ordinances
adopted by the City of Wheat Ridge. Work is subject to field inspections.
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 to 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
perfrmed th Il work to be performed is disclosed in this document and/or its' accompanying approved plans and specifications.
Signature of OWNER or bNTRACI9R-, ircle one) Date
1, This permit was issued based on
on 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 rcies 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 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 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`gfthis lunsdicti App p al fwork is subject to field inspection.
,,bUX�Aa
Signature of Chief Building Official Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
1 L Y of
CpMMUN17,DEVE t 1 e
Bui/din NT
7500 29th A�eection Service
Irl ce' 303-235-2855 heat Ridges ����sion
Pection Line: 303-234_59333-237-892933
AOR pFFICE USE ON]
I Date.
0l�
plan RevlewF�:
�
Please B
complets all high/i uilding Per
9hted area,r►l
Propeit q
°n
�YAddress_ Y both sides of pl�cat;on
�ropen'Y Ow � this fore,. ►nco
replete app/icatio s d,
ner (p/easy ir�r� :L r , ns may not bB Pr®yes e
Property Owner
Email
Mailing Address:
Amoss:
Sta
(ifraiffe�-ent than propert
` 2t l � c Y address)
Architeer.-
ct/Engineer E.
mal►;
Contractor: Phone;
�
Detractors City Livens .
e #: '
DDntractor
Email Address: .2.
ab Contractors:
�trical.
City License #
City Licensed Sub:
:ease #
Plumbing.
W.R.
CitY License #
Pine:
Phone
4a .7 5
Mechanical:
w•R• City License #
OtY Lic rl Licensed Sub:
erase #
Complete all informatio
n on 130T11sides Of this form
From: no-reply@ci.wheatridge.co.us
Sent: Friday, July 21, 2017 12:32 PM
To: CommDev Permits
Subject: Online Form Submittal: Residential Roofing Pe mit Application
Categories: Gina
Residential Roofing Permit Application
This application is exclusively for new permits for residtiaof' and for licensed
contractors only. This type of permit is ONLY being proc ed online --do not come
to City Hall to submit an application in person. Pe r rocessed and issued in
the order they are received and due to the volu of r time to process
varies and ' change. YOU WILL BE T D WHEN YOUR
PER S READY F PICK-UP AND WILL BE SPECIFIC DATE
A TIME WINDOW T COMPLETE THE TR ACTT N. You will be notified if
y contractor's license r insurance has expir nd yo may update those
dod��nts at the time y u are issued your pe
KFr all other reques
meowners wishing to obtain a roofing
at City Hall. Revisions to exis,king permit:
completed in person at City HW4ib.All othE
erson at City Hall. The Building or
son
hiriday to process the
THIS APPLICATIT DOES NOT CONS -1779%
ROOFING UN L PERMIT HAS BEEN ISS
Is this plication for a Yes
ing units Single mily Home
ry?
DRMATION
285 Eaton St (
Property Owner Name N TrE& Harriso
Property
Number
Property
Address
mpleted.
Imply for the permit in person
add redecking) must be
1 permits must be completed in
i from 7:30-10:30 a.m.,
uests.
A PERMIT. DO NOT BEGIN
Do you have a signed
No
contract to reroof this
property?
It will need to be
provided at the time of
permit pick-up.
CONTRACTOR INFORMATION
Contractor Business
Grissom Contracting
Name
Contractor's License
1,7.0128 `}1�
Number (for the City of
Wheat Ridge)
Contractor Phone
r �
(303)204-0408
Number
Contractor Email Address
John@(TissomContracting.com
Retype Contractor Email
John@Gris8omContracting.com "
Address
DESCRIPTION OF WORK
W
Are you re -decking thec
.
roof?
Description of Roofing
Architectural Asphalt Shingle
Material
Select Type of Material:
Asphalt R
If "Other" is selected
Field not completed.
above, describe here:
How many squares of the
25
material selected above?
u
Does any portion of the
No
property include a flat
roof?
t
If yes, how many squares
Field not completed.
on the"flat roof?
TOTAL SQUARES
25
(pitched + flat) of all
roofing material for this
project
2
Provide additional detail 4:12 Pitch
here on the description of
work. (Is this for a house
or garage? What is the
roof pitch? Etc)
Project Value (contract $600.00
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 John Grissom
Email not displaying correctly? View it in your browser.
3
Property
Property Addressl C-t)k5) Phone:
CO
Contractor License No.:
Company
Phone
Construction Vaal e.
Permit Fee:
Plan Review `ee:
Description: 1 „ e r
1/
300 .•
Electrical License No: Plumbing License No `r 7, 1 Mechanical License No:
Company: Company: Company;
' City of Wheat Ridge
�
Residential Roofing PERMIT - 091172
PERMIT NO: 091172 _ ISSUED: 08/07/2009
JOB ADDRESS: 3815 -3817 Parfet St EXPIRES: 12/31/2010
DESCRIPTION: Reroof 27 sqs
* ** CONTACTS * **
owner- 303/898 -8498 Jim Cook
sub 303/237 -5179 Curt Marceau 02 -2364 Roofing Plus
** PARCEL INFO **
ZONE CODE: UA USE: UA
SUBDIVISION: 0190 BLOCK /LOT #: 0/
** FEE SUMMARY ** ESTIMATED PROJECT VALUATION: 6,200.00
FEES
Extend Expired - Permi 90.55
Permit Fee 181.10
Total Valuation .00
Use Tax 111.60
** TOTAL ** 383.25
Conditions:
6 nail installation & mid -roof inspection required. Board sheathing spaced more
than a 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.
Subject to field inspections.
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.
Signature of contractor /owner date
1. 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.
2. 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.
3. 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 shall
be paid for a new permit.
4. No work of any manner shall be done that will change the natural flow of water causing a drainage problem.
5. 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.
6. The issuance of a permit or the approval of drawings and specifications shall not be construed to be a permit for, nor
an approval of, any violation of the provisions of the building codes or any other ordinance, law, rule or regulation.
All plan review is subject to field inspections.
.Signature of Chief Building Official date
INSPECTION REQUEST LINE: (303)234 -5933 BUILDING OFFICE: (303)235 -2855 REQUESTS MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
♦�
V 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
Permit Number 04 #77
�YLrlfl � f Yl
t /1 ( u. /:: qlf lit "i. VYMI, /"WC
J J
f�
❑ No one available for inspection: Time 6W OM
Re- Inspection required: Yes No
ICE
♦ A i CITY OF WHEAT RIDGE
=,- t Building Inspection Division
(303) 234 -5933 Inspection line
(303) 235 -2855 Office • (303) 235 -2857 Fax
INSPECTION NOTICE
Job Address:
Permit Number: Ow t I j
❑ No one available for inspection: Time AM /PM
Re- Inspection required: Yes No
When corrections have been made, call for re- inspection t 303 - 234 -5933
Date: nspector:
D NOT REMOVE HIS NOTICE
Parfet::-St"
sqs
a'
OFw"Egr,P City of Wheat Ridge Building Division
m 7500 W. 29th Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-235-2857
0 o Inspection Line: 303-234-5933
OLORP~
Date: 6 b l / 1/9
Plan
Permit 67C r l7~
Building Permit Application
Property Address: ~ery?&
Property Owner (please print): T copt
Mailing Address: (if different than property address)
Address:
Phone:
75
State,
Contractor: I"
Contractor License
Sub' Contractors:
Electrical City License #
Company:
Exp. Date:
Z Phone:
Plumbing City License
Company
Exp. Date:
Use of space (description):
Description of work:
Sq. Ft./L.Ft added:
Squares -9- BTU's
-15,
Mechanical City License
Company:
Exp. Date:
ruction Value: $ (/JC /--,U - 4,C-.
(as calculated per the Building Valuation Data sheet)
Plan Review (due at time of submittal): $
Gallons _ Amps