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Home My WebLink About10895 W 41st Avenue- Occupancy/ i tme INSPECTION RECORD � INSPECTION ONLINE FORM: http://www.ci.wheatridge.co.us/inspection INSPECTION REQUEST LINE: (303) 234-5933 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 To Approval Of The Above Inspections Underground/Slab Inspections Date Inspector Comments Initials 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 ?j 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 A City of Wheat Ridge ' Residential Roofing PERMIT - 201704634 PERMIT NO: 201704634 ISSUED: 07/24/2017 JOB ADDRESS: 10895 W 41st AVE EXPIRES: 07/24/2018 JOB DESCRIPTION: Residential Re -roof to install GAF Timberline HD asphalt shingles with 13 sq.(3sq flat) Tear off existing roof to deck and replace. House- 13sq, pitch 4/12, Note(Flat roof patio portions are not being redone and are not in the scope of work.) *** CONTACTS *** OWNER (303)513-9692 MIKUS CAMERON C SUB (303)233-7663 Ben McFerron 070157 Premier Roofing Company *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2403 / APPLEWOOD VILLAGES, PROSPECT V BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 3,341.00 FEES P I Total Valuation 0.00 Use Tax 70.16 Permit Fee 109.20 !� ** TOTAL ** 179.36 *** 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 one half 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 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. IV City of Wheat Ridge ter, Residential Roofing PERMIT - 201704634 PERMIT NO: 201704634 ISSUED: 07/24/2017 JOB ADDRESS: 10895 W 41st AVE EXPIRES: 07/24/2018 JOB DESCRIPTION: Residential Re -roof to install GAF Timberline HD asphalt shingles with 13 sq.(3sq flat) Tear off existing roof to deck and replace. House- 13sq, pitch 4/12, Note(Flat roof patio portions are not being redone and are not in the scope of work.) 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 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 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 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 an all not proceed or conceal work without written approval of such work from the Building and Inspection Services Division. • 6. The issuance��P)cref construed to be a permit for, or an approval of, an violation of any provision of any applicable co this jurisdiction. Approval of work is subject to field inspection. 1 f no Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Dan Schultz c6c(l -76 From: no-reply@ci.wheatridge.co.us Sent: Thursday, July 13, 2017 3:08 PM To: Permits CommDev 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 Property Owner Name Property Owner Phone Number Property Owner Email Address 10895 W. 41 st Ave Mikus, Cameron 303-513-9692 amccoy@premier-roofing.com 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 Contractor's License Number (for the City of Wheat Ridge) Contractor Phone Number Premier Roofing Company 70157 3039526873 Contractor Email Address amccoy@premier-roofing.com Retype Contractor Email amccoy@premier-roofing.com Address DESCRIPTION OF WORK Are you re -decking the No roof? Description of Roofing GAF Timberline HD Material Select Type of Material: Asphalt If "Other" is selected Field not completed. above, describe here: How many squares of the 13 material selected above? Does any portion of the Yes property include a flat roof? If yes, how many squares 3 on the flat roof? TOTAL SQUARES of all 13 roofing material for this proj ect 2 Provide additional detail here on the description of work. (Is this for a house or garage? What is the roof pitch? Etc) Project Value (contract value or cost of ALL materials and labor) Tear off existing roof to deck and replace. House - 13 SQ's. Pitch: 4/12. NOTE: Flat roof patio portions are not being redone and are not in the scope of work. 3,250 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 Alison McCoy Email not displaying correctly? View it in your browser. 3 N ..,��.. Colorado sprit 1�a"siie'r Eliig /►._ Kaneda Cut MIER COMPANY 1-855-RO#�E-�2i oonit dwdAmW i lr pfemilef-roofing.coni Chicago sem:*"@ AGREEMENT THiS AGREEMENT SUBJECT TO INSURANCE COMPANY APPROVAL Name: _C.A ^VtQAt4 Date:5�Z'I I" Address: 104A,1,5 W L/1:51 A Ji=g City/State:1p:_ Email: Fzttgf:,wa�ra�A�, _ ►' r,�x�+� r eStPhone: 3c� 5th-'916ciZ. _. Billing Address: City/State: _ Co zip;_ ROOFING SPECIFICATIONS - EXISTING ROOF. DAMAGES FOUND DURING INSPECT10M o Steep Slope 9( Low Slope R fin 0 Composition Shingle oWood aMetai oOther. North Slope: /rp t s/S Q xsingle Ply Membrane: oModified oBuilt Up South Slope: x VRoof Grade: Ridge: East Slope: " f' ,0 Pitch: �J12 2 -Story oYoN Diff. Access: oYoN West Slope: XLayers: Z Types: Other Damapaes: KDecking Type:oPiywoodrOSB oSpaced oOther v Fasteners per shingle:# ? oStaples oNails m'Deck Protection: p'Valley material: LF RRQwmmendations: Vents:750's Turbines Bath Ridge_LF prPlumbing lacks: Sm 1.t*�_____ oMetai Edging oYoN oRakes oEaves ,oStep Flashing oCounter Flashing aReglet o0ther fa Skylights: pRefiash oReplace _# Size ;d Leak Barrier Existin oYoN WARRANTIES: Weather Stopper System: oY ON Workmanship: 02 -Yr p10 -Yr Premier ❑ 25 -Yr Golden Pledge MaLegrjata: o5 -Yr (Shingle Only) 9f5O-Yr Full System PAYMENT SCHEDULE First (ACV) or 1/3 payment due on day of construction Final payment due upon Invoice Paid Date: I J CK# @$ Paid Date: ! J CK# @$ Paid Date:--J---J— CK# @$ State Law: Any Payments to Be Held in Trust Premier Roofing shall hold in trust any payment received from you until Premier Roofing has delivered roofing materials at the site or has performed a majority of roofing work on your property. a Leak Barrier at: a Eaves tt,Sidewalis iuValieys sPenetrotions uSkylights &Fasteners Per Shingle:,_ _ m Replace Vents mReplace Flashing * Install Gutter Apron t%lnstall Rake Metal &Paint All Roof Accessories %Protect Landscaping igRemove All Debris igRoll Property with Magnet aLFurnish Permit (Where Required) c3 Special Project Upgrades: Quantity: Unit: Price: $ _ (in addition to insurance proceeds and deductible) oSpecial Property Protection Measures: Terms: This agreement does NOT obligate the property owner or PREMIER ROOFING in any way unless the insurance claim is approved by the insurance company and accepted by PREMIER ROOFING. By signing this agreement the property owner authorizes PREMIER ROOFING to pursue property owner's best interests for a roof replacement at a "PRICE AGREEABLE" to the insurance company and PREMIER ROOFING with no cost IQ the propelowner except for the Insurance deductlble When "PRICE AGREEABLE" is determined, the final contract amount shall be equal to the Insurance Proceeds and Deductible, and property owner authorizes PREMIER ROOFING to provide labor and material in accordance with this Agreement and tqe specifications set out herein and on the reverse side hereof to accomplish the roof replacement. Accepted by:—Ln ''Z,t'2 Dater/ t t insurance Co.: v PAA016t�.r Claim#: 3008(.6$121 Mortgage Co.: Deductible Amount:$ 1000 Field Representative: 6r,(_} Management Approval: Scanned by CarnScanner ,l CITY OF WHEAT RIDGE Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: ! ~ t r Job Address: Permit Number: Q ❑ No one available for inspection: TimeAM/PM Re -Inspection required: Yes When corrections have been made, call for re -inspection at 303-234-5933 Date: / �,� Inspector: 1 . DO NOT REMOVE THIS NOTICE A i CITY OF WHEAT RIDGE �9Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: r`" L Job Address: f'� _`"`' !' s %1 `' Acc Permit Number: ❑ No one available for inspection: Time = = AWPM Re -Inspection required: Yes /No When corrections have been made, cal/ �foorr re -inspection at 303-234-5933 Date: / — Inspector: p DO NOT REMOVE THIS NOTICE 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: Iq 17 Job Address: 2 W '215" Ave Permit Number: 27o/ `> d"j" a ,/ ,/ f t ❑ No one available for inspection: Time Re -Inspection required: , ,/No When correction have been made, call -for -re-inspection at 303-234-5933 Date: �� Inspector: DO NOT REMOVE THIS NOTICE ♦ 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: /~rfcJ~Go~ Job Address: /Oggs ~✓G?Si 111 15 AU Permit Number: ❑ No one available for inspection: Time AM/PM Re-Inspection required: Yes No ' When corrections have been made, call for re-ins ect n 03-2345933 Date: /b -/b-a Inspector: DO NOT REMOVE THIS NOTICE City of Wheat Ridge _r- Residential Roofing PERMIT - 093367 PERMIT NO: ` 093367 ISSUED:: 10/15/2009 JOB 'ADDRESS:. 10895 W 41ST AVE EXPIRES: 04/13/2010 DESCRIPTION:. Reroof 15 sqs ***CONTACTS owner 303/513-9692 Cameron Mikus sub 303/980-2479 William Scott 09-0414 Roofing Service Specialists **'PARCEL INFO ZONE'. CODE: UA -USE: UA SUBDIVISION:- 0189 :BLOCK/LOT#: 0/ FEE SUMMARY ESTIMATED PROJECT VALUATION: 5,600.00 q-. FEES ( ' Permit Fee 162.90 Total Valuation .00 .F Use Tax 100.80 TOTAL 263.70 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.:. ***Contractor/Property owner shall provide `ladder(s) secured in place for inpsections.! Subject to field inspection. 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 measurement /vPown, and el egations made are accurate; that I have read and agree to abide'. by all conditions printed on this applicatiax~d that I ku full responsibility for compliance with the Wheat Ridge Building Code (I.B. c) and all other applicab e Wtea id a d' a ,..-f~ werk under this permit. Plans subject to field inspection. Stgnatu e of contractor/owner 'date L 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 maybe 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 bepaid 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. 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. o. The. issuance,~of a permit. or the approval of drawinas and specifications shall' not be construed to be a hermit for. nor Q City of Wheat Ridge Building Division 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 Inspection Line: 303-234-5933 Building Permit Application P~opgrtyAddress: /j/ 1S74 Property Owner (please print): Date: Plan M Permit #:.D> Phone: 303..6-/5 E6 Mailing Address: (if different than property address)e'a n e re N IV 14:615 Address: City, State, Zip: Contractor: d r ! d r Cc° -57 CTC/o <11 A, Contractor License M Phone: 303 ~f6- a '01 Sub Contractors: Electrical City License Company: Plumbing City License Company Mechanical City License* Company: Exp. Date: Exp. Date: Exp. Date: Approval: Approval: Approval: Use of space (description): Construction Value: $ c5 g~ 00 CIV D,PC 'ription of work: (as calculated per the Building Valuation Data sheet) e 6o /'v ~L~p m°~Crc " - tp,e Ao Plan Review (due at time of submittal): $ Sq. Ft./L.Ft added: Squares BTU's Gallons Amps 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 t Wheat_ idge Building Code (I:B.C) and all other applicable Wheat Ridge Ordinances, for work under this permit. Plans st bjee Weld mspec 'on. ClRLCE ONE:: (OWNER (CONTRACT or PERSONAL REPRE /T,A~T~LVE of R) (CONTRATOR) PRINT NAME: G.~tl ~j Y~" SIGNATURE: Date: .~~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: P&2~ v ~r FFC« ,f,v > Job Address/Permit Number: ~osrs w. s~/4T /yj~ ❑ No one available for inspection: Time AM/PM Re-Inspection required: Yeso When corrections have been made, call for re-inspection at 303-234-5933 Date: Inspector:C DO NOT REMOVE THIS NOTICE " ' City of Wheat Ridge -rr Residential Plumbing PERMIT - 081414 )ERMIT NO: 081414 ISSUED: 12/09/2008 COB ADDRESS: 10895 W 41ST AVE EXPIRES: 06/07/2009 )ESCRIPTION: Repair 40' of sewer line in front yard CONTACTS )wner 303/513-9692 Cameron Mikeus (0 303/696-9599 Steve Wakeham 01-9921 Pipeline Industries, Inc. PARCEL INFO :ONE CODE: UA USE: UA SUBDIVISION: 0189 BLOCK/LOT#: 0/ FEE SUMMARY ESTIMATED PROJECT VALUATION: 2,500.00 FEES Permit Fee 108.30 Total Valuation .00 CI.bD(Q. Use Tax 45.00 TOTAL 153.30 itions: Owner/Contractor is responsible for locating proeprty lines and tructing improvements according to the approved plan and required lopment standards. The City is not responsible for inaccurate information itted within the plan set and any construction errors resulting from curate information. 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. 12 -q-0 Signature of contractor/owner 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. 1. 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. F. No work of any manner shall 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. 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 subct s field inspections. ~f >ignature of Chief Bu din. ff icial date INSPECTION REQZ ST LINE: (303)234-5933 BUILDING OFFICE: (303)235-2855 REQUESTS MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. pF WHE??',Q/ City of Wheat Ridge Building Division k* , m 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-235-2857 e o Inspection Line: 303-234-5933 p<Oft P~ Building Permit Application Property Address: Lo 16Q5 W ~A t` aNi Property Owner (please print): Date: Plan Permit Phone: Mailing Address: (if different than property address) Address: q 6 iz City State- Zin: Contractor: Contractor License Phone: O-?J Ciq 6' Q6-Q Sub Contractors: Electrical City License Plumbing City License Mechanical City License Company: Company Company: Exp. Date: Exp. Date: Exp. Date: Approval: Approval: Approval: e (description)~J Q( l(yC ~`C Construction Value: $ Use of spac 7 rld Use of spat \ (as calculated per the Building Valuation Data sheet) Description of work: to ke F(6A ~atf~l AAOf ,an Review (due at time of submittal):$ Sq. Ft./L.Ft added:4J_f Squares BTU's Gallons Amps 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 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 ON (OWNER) CONTRACT ) or PERSONAL REPRESENTATIVE of (OWNER) (CONTRATOR) PRINT NAM ( ~L SIGNATURE:. ce ~_~1 .1 nib Date: IG` DEPARTMENT USE'ONLY ZONING COMMENTS: ' Zoning: Reviewer. PUBLIC WORKS COMMENTS: Reviewer: BUILDING DEPARTMENT COMMENTS OCCUPANCY: Reviewer. Bld Valuation: $ FIRE DEPARTMENT:: [I approved w/ comments ❑ disapproved El no review required 9