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HomeMy WebLinkAbout2965 Upham StreetCertificate Of Completion Building Division 7500 W 29TH AVE WHEAT RIDGE CO, 80033-8001 Permit#:20090238 Issued: 11/24/2015 Stipulations: Enclose carport and replace the roof. This certificate verifies that the building constructed and/or the use proposed of the building and/or premises, under the above permit number and on property described below, does comply with the Wheat Ridge Building Code and development standards of the zone district in which it is located and may be occupied. All other licensing requirements for the City must be met. wwm�� 150-11rom owner: Julie Tilden 2965 UP HAM ST WHEAT RIDGE CO 80033-8067 Contractor: Edward Horn PO BOX 1500 MONUMENT CO 80132-1500 For the Following Purpose: Res. Garage/Carport Code Editions NO change shall be made in the USE of — 2012 ICC/2014 NEC this building without prior notice — 2006 ICC/2011 NEC and a new Certificate of Completion — 2006 ICC/2005 NEC from the City of Wheat Ridge. Other-j-cx>3' 1CC-1 ....... . . .. . .. Z3'ni—ngAdmini s t CHle f - Bui la:i�ng',11111 'tctor for December 11, 2008 Mr. Roger J. Day R.J. Day Architect 219South Bannock Street Denver, Colorado 80223 Re: Tilden Garage Addition 2965 Upham Street; Wheat Ridge, Colorado New Garage construction built without permit Pursuant, to our conversations on the above referenced project, I have reviewed the photographs and per our conversation I agree that the footings are a turned down extension of the stab on grade extending to 18 inches minimum below the slab grade. While this is not acceptable for occupied construction it is usually considered adequate to extend to a depth of 18" minimum below the slab for garage construction. I am not sure about where the cutoff is when the garage is partially attached to the house but in this case I do not feel that this will cause any harm to the occupied portion of the structure. There tray be some cracking of the wall attached to the house and the owner will have to accept that possibility without any recourse to the City of Arvada or to myself for finding adequacy of the garage structure as it stands. So with the preceding conditions I feet that the structure is adequate as a garage only. No conversion of the structure shall be allowed in the future to any occupied use unless the foundations are revised as well. Please give this letter to the appropriate building official as certification of structural capacity. A copy of this letter should also be signed and accepted by the owner as his acceptance of the above conditions as well and copies forwarded to me and the City of Arvada as a precondition of our allowing the construction to stand as it exists. Please call me if you have any further needs or concerns. Steven F. Wells, P.E. Principal DN: cn=Steven F. Wells, P.E., o=WBC Engineering and CIVI, LLC., ou=No 13997, email=swells @wbceng.com, c=US Date: 2008.12.11 12:49:32 -07'00' 224 Poloniac-Streel, Suile 102-4urora, Colorado 80011 Tel: 303-365-982.5, Fax303-365-9827 WBCEngineering& em, LLe, December 11, 2008 Mr. Roger J. Day R.J. Day Architect 219South Bannock Street Denver. Colorado 80223 Via e-mail. PYAM 4 &FO- ? Re: Tilden Garage Addition 2965 Upham Street; Wheat Ridge, Colorado New Garage construction built without permit Dear Roger: Pursuant to our conversations on the above referenced project, I have reviewed the photographs and per our conversation I agree that the footings are a turned down extension of the slab on grade extending to 18 inches minimum below the slab grade. While this is not acceptable for occupied construction it is usually considered adequate to extend to a depth of 18" minimum below the slab for garage construction. I am not sure about where the cutoff is when the garage is partially attached to the house but in this case I do not feel that this will cause any harm to the occupied portion of the structure. There may be some cracking of the wall attached to the house and the owner will have to accept that possibility without any recourse to the City of Wheat Ridge or to myself for finding adequacy of the garage structure as it stands. So with the preceding conditions I feel that the structure is adequate as a garage only. No conversion of the structure shall be allowed in the future to any occupied use unless the foundations are revised as well. Please give this letter to the appropriate building official as certification of structural capacity. A copy of this letter should also be signed and accepted by the owner as his acceptance of the above conditions as well and copies forwarded to me and the City of Wheat Ridge as a precondition of our allowing the construction to stand as it exists. Please call me if you have any further needs or concerns. Sincerely, Steven F. Wells, P.E. Principal 224 Potomac Street, Suite 102, Aurora, Colorado 80011 Tel: 303 -365 -9825, Fax: 303- 365 -9827 r CITY OF WHEAT RIDGE '( Building Inspection Division j (303) 234 -5933 Inspection line r (303) 235 -2855 Office - (303) 237 -8929 Fax INSPECTION NOTICE Inspection Type _�F� a ma Zw )6a° Job Address vA6,4nr S 7 Permit Number c�JS'ca 23S C -..n A,-, f,+ g' r9�/ Building Permit Application W2111111111111,11! jrwlliii��gammusj#3m sk, Department of Planning and Development Building Inspection Line: 303.234.5933 Building Permit Number: City of Wheat Ridge 7500 West 29th Avenue Date: Wheat Ridge, CO 80215 301235.2855 Property Owner: ci b 0 -,'Ti 14c, n Phone: Property Address: -M WV\k,a4 R09e,60 SQ)3`:� Contractor License No: Company: 0 f) ple wo-a"i 4�? �,t Y'( Phone: :4it"x , OWNER/CONTRACTOR SIGNATURE OF UNDERSTAND NCS 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 I Construction Value:q covenants, easements or restrictions of record; that all measurements shown, and Permit Fee: allegations made are accurate; that I have read and agree to abide by all conditions printedi on this applications and that I assume full responsibility for compliance with the Wheat Plan Review Fee: Ridge Building Code (U.B.C.) and all other applicable Wheat Ridge Ordinances, for work Use Tax: under this permit. (OWNER)(CONTRACTOR) SIGNED* Total: DATE: Description: Z6 )j) qj�)7/ ',we,- 01,11Y SLLle Moeid Set'ViCP (�`­`ha 4/1 Building Department Use Only Zoning Comments: SIC: Sq.Ft.: Approval: Zoning: Building Comments: Approval: No• Plumbing License No: �ieclaanleal License No: ,Electrical License No: Company: Company: iCompan ii ell.i a, I A V, e I C Expiration Date: ' Expiration Date: lExpiration Date: ;Approval i 11� I JApproval: lApproval: " , Regulations and Building Code of Wheat Ridge, Coto rado or any other applicab I le ordinances of the C I ty (2) This permit shall expire if (A) the work authorized is not commenced within sixty (60) days from issue date or (B) the building authorized is suspended or abandoned for a period of 120 days iii 49 IMMIT 11 IRS 11 i W IEPARTMENT OF PLANNING AND DEVELOPMENT Application Numbei— '" "' •DIVISION CITY OF WHEAT RIDGE Date 7500 WEST 29TH AVENUE RIDGE,WHEAT 80215 Property Owner : JAMES MC DOWELL Phone: 303/232-1036 Property Address : 2965 UPiAM STREET Contractor License No. ; 1717 Company: BELL PLUMBING & HEATING Phone R Y4 Construction Value: 513-0 Permit Fee : ..1 Use Tax: Total . Description : WATER HEATER REPLACEMENT w.o. #181902 ..Stories Residential Electrical License No: Plumbing No: Company:, Expiration Date : ExpirationDate xpiration • Approval : Approval : Approval : •Plans Required yopur application and is subject to the laws of the State of Colorado » the Zoning (21 RtIllilitlonsand 8Wding Code of Wboat Ridge, Colorado or any other applicable ordinances of the City Th permit Shalt exave if (A) the wom authorizea is not commenced within sixty (60) days from issue date or (8) the building authorized is suspended or abandoned for a period of 120 days, (3) If this permit expires, a new permit may be acqulrec for a fee of ene-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 are made or it suspension or abandonment exceeds•m paid for a new oermlt. No work of any mamer•.:_ done trial will change tne natural Row w.water causing a drainage ..,. Chief Building Impector For Mayor " ' City of Wheat Ridge Residential Roofing PERMIT - 081062 PERMIT NO: 081062 ISSUED: 09/12/2008 JOB ADDRESS: 2965 UPHAM ST EXPIRES: 03/01/2011 DESCRIPTION: Reroof EPDM installation 35 sqs * ** CONTACTS * ** owner 303/238 -1984 Julie Tilden sub 719/481 -3241 Edward Horn 09 -0050 Horn Industries ** PARCEL INFO ** ZONE CODE: UA SUBDIVISION: 0588 USE: UA BLOCK /LOT #: 0/ ** FEE SUMMARY ** ESTIMATED PROJECT VALUATION: .00 FEES Extend Expired Permi 133.85 No Fees .00 ** TOTAL ** 133.85 Conditions: Referance Plan # 08 -0319 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 appl'b ble Who t Ordinances, for work under this permit. Plans subject to field inspection. 1I(6 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 -fcurl (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 isgsubject to field inspections. Official date T LINE: (303)234 -5933 BUILDING OFFICE: (303)235 -2855 MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. i CITY OF WHEAT RIDGE !� Building Inspection Division (303) 234 -5933 Inspection line / (303) 235 -2855 Office • (303) 237 -8929 FaxT /g f jF— I„5 (0.5 INSPECTION NOTICE 73' I� Inspection Type: Job Address: Permit Number: 0 z-59 a ❑ No one available for i tion: Re- Inspection required: es No "When corrections have be de, I Date: — 4p, 1 Inspector: Time AM /PM for re -in pection at 303 - 234 -5933 NOTICE i CITY OF WHEAT RIDGE f (3 uilding Inspection Division (303) 234 -5933 Inspection line 03) 235 -2855 Office • (303) 237 -8929 Fax INSPECTION NOTICE Inspection Type: L r Job Address: µ> f Permit Number: � �C� !_�C� �V, ❑ No one available for inspection: Time /r f S AM / M Re Inspection required: /Yes No "When corrections have been made, call for {e- inspection at 303-234-5933 Date: ti !U /_ Inspector: DO NOT REMOVE THIS NOTICE i CITY OF WHEAT RIDGE Building Inspection Division r (303) 234 -5933 In ection line P (303) 235 -2855 Office • (303) 237 -8929 Fax INSPECTION NOTICE Inspection Type: f -` Job Address: Permit Number: ❑ No one available for inspection: Time AM %pM Re- inspection required: Y/ es JNo * When corrections have been made, call for re- inspection at 303- 234 -5933 Date: 7 - %( Inspector: - l% DO NOT REMOVE THIS NOTICE i CITY OF WHEAT RIDGE Building Inspection Division r (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: °aar2rSs Job Address: 2q 5 u6~ s~>r 57- Permit Number: ~/.G/'~f%J .r-a G~.r`i,~1 l~Ei2eaa'~ TS ~ Tom!/! w~lcrtrrJ i S. Ejj{ [t i j L f ❑ No one available for inspection: Time 9"4'e AM/PM Re-Inspection required: Yes When corrections have been made, call for re-inspection at 303-2345933 Date: /le, fir? Inspector: DO NOT REMOVE THIS NOTICE o L a CITY OF WHEAT RIDGE Bung Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office • (303) 237-8929 Far INSPECTION NOTICE Inspection Type: G/fig f ,eifv~ a rroly Job Address: X2'/5 vp lw-h4 57- Permit Number: oy02381 dIUSu L.,J~Yi Oriel 91I1 R' tG,L6'I - e;)lL Si-,11 ❑ No one available for inspection: Time AM.PM Re-Inspection required: Yes No When corrections have been made, calf for re-inspection at 303-234-5933 Date: a./ bo Inspector: DO NOT REMOVE TH/S NOT/CE Page 1 of 1 Melissa Mackey From: EDWARD W HORN [ehorn5@msn.com] Sent: Wednesday, March 17, 2010 3:39 PM To: Melissa Mackey Subject: Fw: Building Permit for 2965 Upham St. Melissa Mackey City of Wheatridge Bldg. Dept. Dear Melissa, am writing to request that you remove me, Edward W. Horn, of E-Builds Incorporated as the contractor of record, for the Garage/Carport Building Permit #090238, at 2965 Upham St., Wheatridge, CO, as soon as possible. The owner has not lived up to his promises, or responsibilities on this project, so we have not been able to complete it. I do not want either my contractors license or my reputation to be jeopardized by this project, so I am severing all ties with the owner and the project. Thank you for your assistance in this manner Sincerely yours, Edward W. Horn E- Builds, Incorporated P.O. Box 1500 Monument, CO 80132 Contractors License # 09-0050 3/17/2010 John Schumacher CBO Chief Building Officer City of Wheat Ridge I am writing to request an extension on the permit that was issued for a garage addition that I am having completed at 2465 Upham St. Our original deadline is due to expire on September 16, 2009. We have completed a majority of the work but feel that having an extension on that date would help us with completing the project without leaving to rash through the final stages. Listed below is the name of myself, the contractor teamed on the permit, and the permit number. Also the address of the property where the work is being performed. Thank you, Lance V. Potts Permit 090238 Owner - Lance O. Potts ( 303 238 -1484 } ~GC - Ed Horn ( 719 - 481- 3241) Please call me if there are any questions I can answer . MI'M oFw"~rq City of Wheat Ridge Building Division Date: C1 W Wj "e 7500 W. 29th Ave., Wheat Ridge, CO 80033 m Office: 303-235-2855' Fax: 303-235-2857 Plan ooLORAOO Inspection Line: 303-234-5933 Permit#: Building Permit Application Property Address: uupk. yt^ T Jv co 50Os~, Property Owner (please print): Phone: Il Mailing Address: (if different than property address) Address City, State, Zip: Contractor:` j ll ~y (r~1~~ Contractor License Phone's Il77,1 /1X- ~q 7 Sub Contractors: Electrical City License Plumbing City License Mechanical City License Company: Company Company: Exp. Date: Exp. Date: Approval: Approval: Use of space (description): Description of work: Exp. Date: Approval: Construction Value: $ 3~) 000- (as calculated per the Building Valuation Data sheet) Plan Review (due at time of submittal): $ Sq. FL/L.Ft added: Squares 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. Plan subject to field inspection. CIRLCE O (OWNE (CONTRACTOR) or PERSONAL REPR ENT1Th~~ E of (OW R (CONTRATOR) PRINT NAME: ~ SIGNATURE:.. Dater © ^ DEPARTMENT USE ONLY ZONING COMMENTS: n Zoning: Reviewer: A-D(. 9f't(08- kRw peiaAe tiaf0 vD+ e;,4e4 Seyorld e,Xajh(c PUBLIC WORKS COMMENTS: Reviewer: BUILDING DEPARTMENT C MMENTS: OCCUPANCY:! Review FIRE DEPARTMENT:: ❑ proved W/ comments ❑ disapproved ❑ no review required Bldg Valuation: $ WBW aameenay& ex LLe. December 11, 2008 Mr. Roger J. Day R.J. Day Architect 219South Bannock Street Denver. Colorado 80223 Via e-mail. Re: Tilden Garage Addition 2965 Upham Street; Wheat Ridge, Colorado New Garage construction built without permit Dear Roger: Pursuant to our conversations on the above referenced project, I have reviewed the photographs and per our conversation I agree that the footings are a turned down extension of the slab on grade extending to 18 inches minimum below the slab grade. While this is not acceptable for occupied construction it is usually considered adequate to extend to a depth of 18" minimum below the slab for garage construction. I am not sure about where the cutoff is when the garage is partially attached to the house but in this case I do not feel that this will cause any harm to the occupied portion of the structure. There may be some cracking of the wall attached to the house and the owner will have to accept that possibility without any recourse to the City of Wheat Ridge or to myself for finding adequacy of the garage structure as it stands. So with the preceding conditions I feel that the structure is adequate as a garage only. No conversion of the structure shall be allowed in the future to any occupied use unless the foundations are revised as well. Please give this letter to the appropriate building official as certification of structural capacity. A copy of this letter should also be signed and accepted by the owner as his acceptance of the above conditions as well and copies forwarded to me and the City of Wheat Ridge as a precondition of our allowing the construction to stand as it exists. Please call me if you have any further needs or concerns. Sincerelv. Steven F. Wells, P.E. Principal DN: cn=Steven F. Wells, P.E., o=WBC Engineering and CM, LLC., ou=No 13997, email=swells@wbceng.com, c=US Date: 2008.12.11 14:04:02 -07'00' G 224 Potomac Street, Suite 102, Aurora, Colorado 80011 Tel. 303-365-9825, Fax: 303-365-9827 NBC, mo,Neeroff& ex LLe. December 11, 2008 Mr. Roger J. Day R.J. Day Architect 219South Bannock Street Denver. Colorado 80223 Via e-mail. Re: Tilden Garage Addition 2965 Upham Street; Wheat Ridge, Colorado New Garage construction built without permit Dear Roger: Pursuant to our conversations on the above referenced project, I have reviewed the photographs and per our conversation I agree that the footings are a turned down extension of the slab on grade extending to 18 inches minimum below the slab grade. While this is not acceptable for occupied construction it is usually considered adequate to extend to a depth of 18" minimum below the slab for garage construction. I am not sure about where the cutoff is when the garage is partially attached to the house but in this case I do not feel that this will cause any harm to the occupied portion of the structure. There may be some cracking of the wall attached to the house and the owner will have to accept that possibility without any recourse to the City of Arvada or to myself for finding adequacy of the garage structure as it stands. So with the preceding conditions I feel that the structure is adequate as a garage only. No conversion of the structure shall be allowed in the future to any occupied use unless the foundations are revised as well. Please give this letter to the appropriate building official as certification of structural capacity. A copy of this letter should also be signed and accepted by the owner as his acceptance of the above conditions as well and copies forwarded to me and the City of Arvada as a precondition of our allowing the construction to stand as it exists. Please call me if you have any further needs or concerns. Sincerelv. Steven F. Wells, P.E. Principal DN: cn=Steven F. Wells, P.E., o=WBC Engineering and CM, LLC., ou=No 13997, email=swells@wbceng.com, c=US Date: 2008.12.11 12:49:32-07'00' 224 Potomac Street, Suite 102, Aurora, Colorado 80011 Tel: 303-365-9825, Fax: 303-365-9827 Driver please go to City of Wheat Ridge and request to re-open Electrical Permit 080730 for the following address: 2965 Upham Street Wheat Ridge, CO 80033 Permit Fee should be $72.35 41 City of Wheat Ridge Residential Roofing PERMIT - 081062 PERMIT NO: 081062: ISSUED: ,09/12/2008 JOB ADDRESS:. 2965UPHAM ST ` EXPIRES: >03/11/2.009 DESCRIPTION Reroof!EPDM installation 35 ;sqs ***'CONTACTS owner 303/238-1,984 Julie Tilden _PARCEL INFO ZONE, CODE: UA USE: UA SUBDIVISION: :r 0588. -BLOCK/LOT#: 0/ FEE SUMMARY ESTIMATED -PROJECT. VALUATION: .~00 FEES No Fees .00 (TOTAL .00 Conditions: Referance Plan # 08.-0319 I hereby certify that the setback distances proposed by this permit application are accurate, and do net 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 T assume full responsibility for compliance with the Wheat Ridge Building Code (i B C) and all other i app rcan e Mhe4 q ordinances, for work under this permit Plans subject to field inspection L ~ `l ( z- Lo g ature of contractor/owner : date i T is permit was issued in accordance with the provisions set forth in your application and is subject to the laws of the ate 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 rtrt be paid for a.'. new permit Z", 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 an inspection card before proceeding with successive phases of the job: s. 6 The issuance of a permit. or the approval of :drawings and specifications shall not be construed to be a permit for, nor z= an. approval. of, any violation of the provisions of the building codes or any other ordinance, law;: rule or regulatier. k; All plan review rs sno 'ec field inspections. Signature of Chief B Official date f, I INSPECTION RE EST LINE: (30.3)234-5933 BUILDING OFFICE. (303)235-2855 REQUESTS MUST BE MADE BY 3PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. - r t" w: k oFw"EtrR, City of Wheat Ridge Building Division Date: 1 m 7500 W. 29th Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 " Fax: 303-235-2857 Plan M o Inspection Line: 303-234-5933 O<ORA~ Permit Building Permit Application Property Address: ze2bf~~ up&6,~ ~ ~L Property Owner (please print).( r( ~f Q~ Phone: Z 3 S gy Mailing Address: (if different than property address) Address: City, State, Zip: Contractor: Contractor License M Sub Contractors: Electrical City License Plumbing City License Mechanical City License Company: Company Company: Phone: Exp. Date: Exp. Date: Exp. Date: Approval: Approval: Approval: Use of space (description): Description of work: Ra,,0bJ1!~Ip Jr/N I v1 It y( c9~ Construction Value: $ 1 e{, C9oc~ (as calculated per the Building Uafu'atlon Data sheet) 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 the Wheat Ridge Building Code (I.B.C) and all other applicable Wheat Ridge Ordinances, for work under this permi~t.'PlansIubject to field inspection. CIRLCE ONr~ (pWNEm' (CONTRACTOR) or PERSONAL REPRESEI TAT E of R) (CONTRATOR) PRINT NAME: ~~U;~1_ t _ °PY1 SIGNATURE: Date: - I ZONING COMMENTS: Zoning: Reviewer: PUBLIC WORKS COMMENTS: Reviewer. DEPARTMENT USE ONLY BUILDING DEPARTMENT COMMENTS: OCCUPANCY: Reviewer: FIRE DEPARTMENT:: ❑ approved w/ comments ❑ disapproved ❑ no review required Bldg Valuation: $