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Home My WebLink About3965 Ammons StreetPERMIT: ,j�[r73s ADDRESSl1r JOB CODE: Rough Inspection (continued) Date Inspector Initials Comments 316 Rough Mechanical Residential 317 Rough Mechanical Commercial 318 Boiler / Furnace 319 Hot water tank 320 Drywall screw and Nail 321 Moisture board / shower walls 322 Rough Grading 323 Miscellaneous Final Inspections Date Inspector Initials Comments 402 Gas Meter Release 403 Final Electrical Residential 404 Final Electrical Commercial 405 Final Mechanical Residential 406 Final Mechanical Commercial 407 Final Plumbing Residential 408 Final Plumbing Commercial 409 Final Roof 410 Final Window/Door i,. 411 Land scape/Park/Pl an n i ng* Inspections from these entities shall be requested one week in advance. *For landscaping and parking inspections please call 303-235-2846 **For ROW and drainage inspections please call 303-235-2861 ***For fire inspections please contact the Fire Protection District for your project. 412 Row/Drainage/Public Works** 413 Flood plain Inspection** 414 Fire Insp. / Fire Protection*** 415 Public Works Final** 416 Storm Water Mgmt.** 417 Zoning Final Inspection* 418 Building Final Inspection 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 by the Fire District and Electrical low voltage by the Building Division. INSPECTION RECORD Inspection online form: http://www.ci.wheatridge.co.us/inspection Cancellations must be submitted via the online form before 8 a.m. the day of the inspection Inspections will not be performed unless this card is posted on the project site Request an inspection before MIDNIGHT (11:59 PM) to receive an inspection the following business day PERMIT: bj34-+5 ADDRESS: ,�q - JOB CODE: Foundation Inspections Date Inspector Initials Comments 102 Caissons / Piers 103 Footing / P.E. Letter 104 Foundation Setback Cert. 105 Stem Walls 106 Foundation wall Insulation Do Not Pour Concrete Prior To Approval Of The Above Inspections Underground / Slab Inspections Date Inspector Initials Comments 201 Electrical / Cable/ Conduit 202 Sewer Underground Int. 203 Sewer Underground Ext. 204 Plumbing Underground Int. 205 Plumbing Underground Ext. 206 Water Underground )U Z Do Not Cover Underground or Below I In -Slab Work Prior To Approval Of The Above Inspections Rough Inspection Date Inspector Initials Comments 301 Rough Framing 302 Wall Sheathing 303 Roof Sheathing 304 Sheer Inspection 305 Insulation 306 Mid -Roof )U Z 307 Metal / Lath / Stucco 308 Rough Electrical Residential 309 Rough Electrical Commercial 310 Electrical Meter Residential 311 Electrical Meter Commercial 312 Temp. Const. Meter 313 Rough Plumbing Residential 314 Rough Plumbing Commercial 315 Shower Pan SEE OVER FOR ADDITIONAL INSPECTIONS Lr i CITY OF WHEAT RIDGE Building lryspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: / c Job Address: 3 c7 6 S Permit Number: -3 c 1 `7 0 -7 3 Ll .Sell C\ — i O C4 C/C ❑ No one available for inspection: Time q = ) M/ M Re -Inspection required: Yeses When corrections have been made, call for re -inspection at 303 -234 - Date: i a h? 1 ► -7 Inspector: DO NOT REMOVE THIS NOTICE o ° , City of Wheat Ridge s '( Residential Roofing PERMIT - 201707345 PERMIT NO: 201707345 ISSUED: 09/18/2017 JOB ADDRESS: 3965 Ammons ST EXPIRES: 09/18/2018 JOB DESCRIPTION: Residential Re -roof to install GAF asphalt shingles - 28 sq Pitch = 2/12 *** CONTACTS *** OWNER (303)420-8851 IGNELZI JULIE A SUB (720)708-4126 Terry Marks 130138 Home Guard Services LLC *** 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: 7,196.00 FEES Total Valuation 0.00 Use Tax 151.12 Permit Fee 172.60 ** TOTAL ** 323.72 *** 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. Midroof & Final Roof inspections for ROOFS 6/12 PITCH & OVER: 3rd party inspection will be required, the 3rd party inspection report AND THE ORIGINAL PERMIT CARD needs to be dropped off to the Permit Desk at the City of Wheat Ridge. The report MUST BE SIGNED by the Homeowner. City of Wheat Ridge 3 _A� Residential Roofing PERMIT - 201707345 PERMIT NO: 201707345 ISSUED: 09/18/2017 JOB ADDRESS: 3965 Ammons ST EXPIRES: 09/18/2018 JOB DESCRIPTION: Residential Re -roof to install GAF asphalt shingles - 28 sq Pitch = 2/12 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 permit. I further attest that I am legally authorized to include all entities named within this document as parties to the work to be performed and that all Pvork to be performed is disclosed in this document and/or its' accompanying approved plans and specifications. Signature of OWTEYZ or_ COkTgACTOR (Circle one) Date l 1. This permit was iAued based on the information provided in thepermit 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 original pennit 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 changeof 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 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. Lovett � 170 / l T Dane 4�_ From: no -reply@ ci.wheatridge.co.us --- Sent: Tuesday, September 12, 2017 2:18 PM G To: CommDev Permits Subject: Online Form Submittal: Residential Roofing Permit Application Follow Up Flag: Follow up 5 Flag Status: Completed 1 C�- Residential Roofing Permit Application 7:70 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 inr 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 c your contractor's license or insurance has expired, and you may update those documents at the time you are issued your permit. -4- 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 1) t_ Property Address 3965 Ammons St. Property Owner Name Property Owner Phone Number (enter WITH dashes, eg 303-123-4567) Julie Rodriguez 303-420-8851 137 Property Owner Email Address Do you have a signed contract to reroof this property? Applications cannot be submitted without an executed contract attached below. Attach Copy of Executed Contract Field not completed. Yes Rodriguez Contract.pdf CONTRACTOR INFORMATION Contractor Business Homeguard Roofing and Restoration Name t_ Contractor's License 130138 Number (This is a 5 or 6 digit number for the City of Wheat Ridge) Contractor Phone Number (enter WITH dashes, eg 303-123-4567) Contractor Address (Primary address of your business) 720-708-4126 6850 W 52ND AVE SUITE 106 Contractor Email Address fernl@homeguardroof.com Retype Contractor Email fernl@homeguardroof.com Address DESCRIPTION OF WORK TOTAL SQUARES of 28,- the 8fthe entire scope of work: Project Value (contract Loq-- value or cost of ALL i ;I materials and labor) �- 1 (� Are you re -decking the No / roof? 138 Does the scope of the No project include a flat roof (less than 2:12 pitch)? Does the scope of the Yes project include a pitched roof (2:12 or greater pitch)? What is the pitch? 2:12 How many squares are 28 part of the pitched roof? Describe the roofing Modbit 4ddGAF Timberline HD materials for the pitched roof: Type of material for the Other pitched roof: If "Other" is selected Modbit above, describe here: Provide any additional Replacing roof on house and shed detail here on the description of work. (Is this for a house or garage? Etc) 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 139 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. Name of Applicant Terry Marks Email not displaying correctly? View it in your browser. 140 004 Colony Insurance- Policy Number OTE2136o Contact: GIA Risk Management, 13031423-0162, ext. 136 HOMEGUARD6850 W. 52nd Avenue Suite tOb Arvada. CO 80002 Y' �'""� s • ' ` T ROOFING & RESTORATION Office 720.708.4126 Fax: 720.9 21.8658 IYlasfer ilte BB8- info@HomeGuardRoof.com HomeGmeGuardRooEcom CUSTOMER INFORMATION (� p(,� M,-,P7S Z Address: / (q �� Name: 1 Ziptaa 3 City: Project Address: (if different from above) 76U't � 0 -� q .5`/ ll u Ffome#: 63�� Celt f Gjg - 3 r7/ Email: Insurance Company: rf'tri SL Claim No: Z / Deductible: 2. C� N�- Phone: awe_ Sales Representative: Name: (.3v 3 } 13 — Z 8 3 [� Project Manager: Name: Phone: t STR TURESINCLUDEffD FrVpdge ufacturer:�ze: Material: Underlayment: Leak Barrier Drip Edge Lid t�ves Flashing � ewall, Ventilation Turtte NEW ROOFING SYSTEM: SC E OF RESTORATION SERVICES TO BE PROVIDED lain [etaef Other — 31)1.11 Type: JG SERVICE AGREEMENTS _ Cotor: GAF ROOFING SYSTEMS 50 -year 50 -year V Per Code Penetrations ��❑,,,,,, ��y ,.�,/ manufacturer warranty manufacturerwarranty akes [I Color Ort. 25 -year servicepoticy 10 -year servicepoUcy Chimney Non -Prorated {; Nen-Prorated ❑ f;Xge ❑ E4e ❑ Other Transferrable 7 Transferrable • STANDARD w -year 10 -year manufacture minty manufacturerwarranty S -year service policy 2 -year workmanship warranty _Prorated AQL Prorated Tran$erratie Plumbing Boots UJI [Paint Alt Roof Accessories a=Zrkmanship E emove trash from roof gutters & yard Material - lawn & drive with magnetic sweeper Manufacture Standard Furnish permit ❑Miscell)<eous: Workmanship5yrs ROOF SYSTEM Out-of-pocket upgrade costs LOW SLOPE AREAS Material Manufacturer Coto —..C—�-- stomer Iniyals ADDITIONAL AREAS OF CONSTRUCTION: SCOPE OF RESTORATION SERVICES TO BE PROVIDED All additional areas of construction will be repaired or replaced with high grade materials of like kind and quality SERVICE AGREEMENT ❑ Gutrs ❑ Painttain ❑ SiTg ❑ Winws ❑ Intior ❑ Skight ❑ Oer STANDARD Material - Manufacture 5 and or Notes: Repan 1 yr Ful placement 2 yrs 'Scope of Restoration Services Provided shall include any additional supplements and services approved by Customers insurance company and accepted b mpany. TERMS OF RESTORATION SERVICES TO BE PROVIDED Th s Agreement does NOT obligate the Customer nor Company in any way unless the insurance claim is approved for repairs or replacement to the above mentioned/written scope of restoration services to be provided by Customer's insurance company and excepted by Company. Customer's signature below signifies acceptance of all terms and conditions of this Agreement, including all terms on the reverse side hereof Customer's total out of pocket expenses are not to exceed insurance deductible plus upgrades for non -insurance items. Customer Payment is due upon completion of each trade Company and its authorized representatives are NOT acting as public insurance adjusters. All works installed per the manufacturer's installation instructions & the local building codes. Agreed Price, E7 - shalt be the total amount due to Company under this Agreement, which is subject to any additi and/or deductions pursuant to authorized insurance upplements or as set forth on the reverse side hereof. Total estimated cost of any non -insurance upgrades shalt be: $ Approximate Oates of Service. Substantial commencement of work shall mean either the physical delivery of materials onto the premises Approximate Come performance tion Date of any labora/nd— shJz�atl be subject to any permissible delays as per provision (41 on the reverse side. Approximate Start Date: js� / t f (7 APP P 7 By signing this Agreement you agree that you have also been provided notice of this richt to cancel orally in addition to the writing contained herein. This contract is subject to Company management review pr 1. I ac above to ms of this contract and authorize Company to proceed. proved and ccepted (Gusto er) pate �7 Approved �Aepted A�omp.nyl Date r Approved and Accepted (Customer] Date I have received the `Things to Remember' docu ni Riot' RIGHT OF CANCELLATION PURSUANT TO FEDERAL REGULATION AND COL. V. STAT. S 5-3-403: YOU, TH YER, MAY CANCEL OR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THIS TRANSACTION AT ANY TIME PRI ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. RIGHT OF CANCELLATION PURSUANT TO COL REV. ST. & 6-22-104: YOU, THE BUYER, MAY CANCEL THIS AGREEMENT AT ANY TIME WITHIN 72 HOURS AFTER YOU HAVE BEEN NOTIFIED THAT YOUR INSURER HAS DENIED YOUR CLAIM TO PAY FOR THE GOODS AND SERVICES TO BE PROVIDED UNDER THIS AGREEMENT. SEE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Company shall hold in trust any payment from Customer until company has delivered the materials to your property or has performed a majority of the work on the property. i CITY OF WHEAT RIDGE _:��Building Inspection Division (303) 234-5933 Inspection line ;r' (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: Job Address:-�Ij�i'XlS�"-' Permit Number: 29 l 70 C --f 5 ❑ No one available for inspection: Time ,;)."3O AM/04"", Re -Inspection required: Yes No When corrections have been made, call fo re -inspection at 303-234-5933 Date: O''�6 ` Inspector:�� DO NOT REMOVE THIS NOTICE 1 ♦ CITY OF WHEAT RIDGE Building Inspection Division f (303) 234-5933 Inspection line (303) 235 -2855 Office • (303) 235 -2857 Fax INSPECTION NOTICE K Inspection Type: .J Job Address: Permit Number: 4 a 1 �1 � ❑ No one available for inspection: Time (-"22 Hiw r� Re- Inspection required: Yes CNo *When corrections have been made, call for re inspection at 303 234 - 5933 Date: 5 7).( Inspector: DO NOT REMOVE THIS NOTICE ♦ i CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 235-2857 Fax INSPECTION NOTICE Inspection Type: /x10"tE,r Job Address: .~`-l wwm,n 4 Permit Number: l414I314- iz P LL d, , Ci i ❑ No one available for inspection: Time a, ANJfPM Re-Inspection required: Yes 'No "When corrections have been made, call for re-inspection at 303-234-5933 Date: 4-; Er Inspector: / DO NOT REMOVE THIS NOTICE Jun 11 04 10:39p Mountain High Roofing 3039862873 p.1 Mountain High Roofing 5305 W. Mississippi Ave. Lakewood, CO 80226 Phone Number: 303-986-3685 Fax Number: '303-986-2873 Email: Mtn high roofing@msn.com Fax Transmittal Form To: Melissa C City of Wheat Ridge From: Kara T. Kenfeld Name: Date Sent: August 14, 2009 CC: Phone: Phone: 303-986-3685 Fax: 303-237-8929 Fax: 303-986-2873 Number of Pages Including cover sheet: 1 RE: Midroof should be occurring today on the following' 3965 Ammons, Wheat Ridge. Owner: Julie Rodriguez o i jb % 05 I I9 1,' Lwq We need a Final Inspeciton for: 7 h~ y~ 10670 W.4e Ave., Wheat Ridge. Owner: Dianne Ott Midroof needed for the following: 10680 W.48'' Wheat Ridge, 80033 Owner: Robin Stephenson. Cq I5q, ug I 'I ( QC-sQ i hc( udk Ftvim,=1- I ) mbacs- Thank you, Kara T. Kenfield Jun 12 04 12:25a Mountain High Roofing 3039862873 PA Mountain High Roofing 5305 W. Mississippi Ave. Lakewood, CO 80226 Phone Number. 303-986-3685 Fax Number: 303-986-2873 Email: mtnhighroofing@msn.com Fax Transmittal Form To., Melissa @ City of Wheat Ridge From: Kara I Kenfield Name: Date Sent: August 14, 2009 CC Phone: Phone: 303-986-3685 Fax: 303-237-8929 Fax: 303-986-2873 Number of Pages including cover sheet: 2 RE: Building permit for - 3965 Ammons St., Wheat Ridge, CO 80033 Hi Melissa, tJ~(l~'~ Thanks f o e info on the correct form to use. We would like to reque a D ROOF for Monday, August 17, if possible. Lou Busnardo, the owner, uld like cl ication on the 6 0 charge. I may have misund rsto ou but thought it was for the inspector to go out to the property and do a midroof inspection? He has not heard of this charge before and said he thought it was included in the cost of the "permit." So if you can itemize it, we will submit it to the insurance company. Thank you, Kara T. Kenfield ' City of Wheat Ridge Faxed Roof Permit PERMIT - 091308 ' PERMIT NO: 091308 ISSUED: 08/14/2009 JOB ADDRESS: 3965 AMMONS ST EXPIRES: 02/10/2010 DESCRIPTION: Reroor.26 sqs,. with 25 yr 3-tabshingles CONTACTS** owner 303/408-3381 Julie. Rodriguez sub 303/986-3685 Lou Busnardo 08-0251 Mountain High Roofing Inc PARCEL INFO ','..ZONE CODE: UA USE: -UA SUBDIVISION:- 0328 BLOCK/LOT#: 0/ FEE SUMMARY ESTIMATED PROJECT VALUATION: 5,200.00 FEES Permit Fee :.162.90 Total •00 DMOD I ` ((4 ' 93.60 TOTAL 256.50 ,..Conditions: -Both front and back of permit need to be posted on. job site. If one or, the other is not present, INSPECTION WILL NOT BE PERFORMED. 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. 9 Subject to field inspections. -.I hereby certify that the setback distances proposed by this permit application are accurate, and do not violate applicable t 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 1% app cable Wheat Ridge Ordinances, for work under this permit. Plans subject to field inspection. s; Signature of con ctor/owner date 2 1. This permit was issuedin 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. g, 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. /7 ~ Signature of Chi ing Official date INSPECTIONAEQUEST LINE: (303)234-5933 BUILDING OFFICE: (303)235-2855 t%REQUESTS MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. tx Jun 08 04 09:21p Mountain High Roofing 3039862873 p.2 City of id a _CI Dale: CJ ~gc pemw 0 IC Building Division 7500 W. 2P Ave., Wheat Ridge, CO 80033 Office: 303-235-2855' Fax: 303237-8929 Inspection Line: 303-2345933 Facsimile Building Permit Application Property Address: 3s (,7s A S+' (-L Co < j Properly Owner (please print): -,Tu i i 2 ec6 P. qu&;t Phone: 3>- y 0 - ~5'ss Use of space (description): t ANC1 C:i2 ~ ~ ~K^g Description ofworlc-rt~ t7cC Yom., Srj ~G1M~~ i tlfj PlanRevrewtdueafffiamOsobwNf.0- Sq Ft/LFt added: Squares -t''BTU's CYdllais Amps ONRJpRNCONTRA07OR SIGNATURE OF UNDERSTANDING AND AGREEMENT 1 hereby ced7y that the seWadr distances proposed by this Per i- appcaton are somnate, and do not violate applicable ordl mnoesn rites w regulations of the city of VNmat Midge a cavenaMs, easements or restrictions of record; nmt an maasaretaaras shoat, and allegations made are amrratc tfmt I have read and agree b abide by all conditions prbted on tit's application and amt I assume full respotuibW for cons fto ce with I a VAteat Ridge 806g Cade g.B.C) and all oBrer applicable Vftmt R"rdga Ordinances. for work underths permit- Plans subject to field irrspedion. - CrRLCEONE:: ~(CONTRACTOR) or PERSONAL 1) (CO lK -2 i N r PRINT RAMS: L.. nit VWiY1G,t't"it~ SRiNA7flttt~tic Dace: COYMSENM 7crrs,g: Reviewer DEPARTMENT USE ONLY OCCUPANCY. Reviewer. Fmet Aem mr- Ffapprovedvdeor,>rrnnts 0 dsapPvovned O rmraviewre pared Bldg VaWOtlatr S Credit Card Payment Use eiredit card /"fisted an file. Print name: Lexi Nsnar& Signature.- Mailing Address: ff diflerent than property address) Address: