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Building & Insertion Services Division 35
7500 W. 29`h Ave., Wheat Ridge, CO 80033 Purr Reviewer
Office: 303-235-2555 * Fax: 303-237-8929
Inspection Line: 303-234-5933
Building Permit Application
Property Owner Email
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Mailing dress* (if different than property address)
Address:
City, State, Zip:
rchitn ngineer E-mail Phone:
Sub contractors:
Electrical: Plumbing: Mechanical:
WR City License # WR City License # W.l . City License #
Other City Licensed Sub: Other City Licensed Sub.
City License # City License
Complete all information on BOTH sides of this form
" m- I g It I I
0 NEW COMMERCIAL STRUCTURE
e► ELECTRICAL#�, SERVICE
y ..air UPGRADE a
NEW RESIDENTIAL STRUCTURE CMMERCIAL
OPING
COMMERCIAL
# ADDITION IORESIDENTIAL ill
r
RESDENTIAL ADDITION WINDOW REPLACEMENT
COMMERCIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.)
RESIDENTIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.)
1,0THER
### ••Ai�.a ••,AI •#CEMENT
PLUMBING SYSTEM/APPLIANCE REPAIR or REPLACMENT
ELECTRICAL
wwa w• A •• REPLACEMENT D" i'
tt°1C1um or materials to oe usea, etc.)
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e:�)OL6e--"
Sq, FULF Stu's Gallons
Amps Squares Other
~yoF"'"E'rpo City of Wheat Ridge Building Division
m 7500 W. 29th Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-237-8929
- - o Inspection Line: 303-234-5933
O<ORP~
Property Address:
Property Owner (please print):
Mailing Address: (if different than property address)
?02 %e/
Address: 317rS r,f l a
City, State, Zip: a &~A-r )P e'er co P02
?
Contractor:
Contractor License Phone:
Sub Contractors:
Electrical City License
Company:
Plumbing City License
Company
Date:
Plan
Permit Mechanical City License
Company:
Exp. Date: Exp. Date: Exp. Date:
Approval: Approval: Approval:
Use of space (description): Construction Value: $
Description of work (as calculated per the Building Valuation Data sheet)
-P ~ OFF ot- D ROOF Plan Review (due at time of submittal): 5
/ )S-rA4L NE- t/ 0AAZ5
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 1 have read and agree to abide by all conditions printed on this application and that 1 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.
C)RLCE ONE:: (OWNER) (CONTRACTOR) or PERSONAL REPRESENTATIV of (O R) (CONTRATOR)
PRINT NAME:( ,4~/F7F'1.~ SIGNATURE Date:
Building Permit Application