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HomeMy WebLinkAbout3780 Independence Streeti CITY OF WHEAT RIDGE Building Inspection Division (303) 235-2855 Office INSPECTION NOTICE Inspection Type: Job Address: Permit Number: ❑ No one available for inspection: Time) �_AMhPM Re -Inspection required: Yes','-. No When corrections have been made, schedule for re -inspection online at: http://www. ci. wheatridge. co. uslinspection DateC^ Inspector: � F DO NOT REMOVE THIS NOTICE - City of Wheat Ridge E -Res. Furnace Replacement PERMIT - 202000337 PERMIT NO: 202000337 ISSUED: 02/18/2020 JOB ADDRESS: 3780 Independence St EXPIRES: 02/17/2021 JOB DESCRIPTION: Replacing 80k, 80% efficiency gas furnace in basement. *** CONTACTS *** OWNER (530)514-5035 MAKAU SEAN SUB (720)876-7166 PHILLIP JENSEN 190033 SENSIBLE ENERGY 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: 4,817.00 FEES Furnace Replacement 40.00 Total Valuation 0.00 Use Tax 101.16 ** TOTAL ** 141.16 *** 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 2012 IRC & 2017 NEC. Smoke alarms shall comply with 2012 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 ARE ADDED SHALL HAVE AN OPERATIONAL CARBON MONOXIDE ALARM INSTALLED WITHIN FIFTEEN FEET OF THE ENTRANCE TO EACH ROOM LAWFULLY USED FOR SLEEPING PURPOSES �f Citgo ®f Wheat Ridge E -Res. Furnace Replacement PERMTT - 202000337 PERMIT NO: 202000337 ISSUED: 02/18/2020 JOB ADDRESS: 3780 Independence St EXPIRES: 02/17/2021 JOB DESCRIPTION: Replacing 80k, 80% efficiency gas furnace in basement. 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 da s 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 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, an violation of any provision of any app]jgable code or a#y,ordinance or regulation of this jurisdiction. Approval of work is subject to f any inspection. Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Cit' of Wheat Ridge CDA022339 AMOUNT 8PSP 378O Indepondonce St 141.16 APPLIPERMIT NO! 20120001-4-3`7 PUMENTRUINE PP / 7320 AUTH CODE� 71362164 TOTAL. ___________ AMOUNT 141.16 141.16 _____________ Dina Kemp From: no-reply@ci.wheatridge.co.us Sent: Monday, February 17, 2020 7:24 AM To: CommDev Permits Subject: Online Form Submittal: Residential Furnace/Boiler Replacement Permit Application Residential 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 Property Address Property Owner Name Property Owner Phone Number (enter WITH dashes, eg 303-123-4567) Property Owner Email Address Attach Credit Card Authorization Form - **DO NOT ATTACHED RANDOM FORMS** 3780 Independence Street Sean Makau 530-514-5035 gcolema@gmail.com Credit Card Auth.pdf CONTRACTOR INFORMATION Contractor Business Sensible Energy Name I Contractor's License 190033 Number (This is a 5 or 6 digit number for the City of Wheat Ridge) Contractor Phone 720-876-7166 Number (enter WITH dashes, eg 303-123-4567) Contractor Email Address jo@sensibleheat.net Retype Contractor Email jo@sensibleheat.net Address DESCRIPTION OF WORK What type of unit is being Furnace installed? Number of BTUs 80000 What is the efficiency 80% (%) of the unit? Is the unit GAS or Gas ELECTRIC? Where is the furnace or Basement boiler located (for example, basement, crawlspace, etc)? Project Value (contract 4817 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 work Yes may not begin on this property until a permit 2 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 Phillip Jensen Permit Email not displaying correctly? View it in your browser. i CITY OF WHEAT RIDGE _:�9�Building Inspection Division (303) 234-5933 Inspection line (303) 235-2855 Office - (303) 237-8929 Fax INSPECTION NOTICE Inspection Type: 14 Job Address: Permit Number: 01 %® 2 1 y ❑ No one available for inspection: Time M Re -Inspection required: Yes /"No When corrections have been made, call for re -inspection at 3,, 0,3-234-5933 Date: Inspector: �OAlr� r )�' - DO NOT REMOVE THIS NOTICE A o City of Wheat Ridge Residential Roofing PERMIT - 201702144 PERMIT NO: 201702144 ISSUED: 06/19/2017 JOB ADDRESS: 3780 Independence ST EXPIRES: 06/19/2018 JOB DESCRIPTION: Re -shingle using asphalt shingles 15 SQ *** CONTACTS *** OWNER (303)956-5181 SASSER RICHARD M GC (303)884-3947 Joshua Bryan 170143 JB Master Builder *** 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: 3,855.00 FEES Total Valuation 0.00 Use Tax 80.96 Permit Fee 109.20 "aY` ** TOTAL ** 190.16 *** 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 Al/z-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 manufacturera€ms 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&#39;s 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. PERMIT NO: JOB ADDRESS: JOB DESCRIPTION City of Wheat Ridge Residential Roofing PERMIT - 201702144 201702144 3780 Independence Re -shingle using ISSUED: 06/19/2017 ST EXPIRES: 06/19/2018 asphalt shingles 15 SQ I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications, applica le building codes, and all applicable municipal codes, policies and procedures, and that 1 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 ermit. I further attest that I am le ally authorized to include all entities named within this document as parties to the work to be performed aid that X11 work to be performed is disclosed in this document and/or its' aFcompanying approved plans and specifications. Sig�Ubjectito turebf O ER or CONTRACTOR (Circle one) Date 1,is permit vas issued based on the information provided in the permit application and accompanying plans and specifications and is the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures. 2. Tmit 5ha11_expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and reprior to the date of expiration. An extension of no more than 180 days made be granted at the discretion of the Chief Building and may be 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, any violation of any provision of any applicable code or any ordinance or regulation of this jurisdiction. Approv` of work is sut to Yield inspection. . Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. Inspection time requests will be accepted by email only. Please email requests to insptimerequest@ei.wheatridge.co.us between 7:30am and 8:00am, the morning of the inspection. Please put the address of the inspection in the subject line. Antoinette Kulick Z p 1 __�, (3 a, ) LAL� From: no-reply@ci.wheatridge.co.us Sent: Saturday, June 10, 2017 2:06 PM To: Permits CommDev Subject:Online Form Submittal: Residential Roofing Permit Application 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. 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. Permits are currently being processed within 3-5 business days, subject to change based on volume. 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. PROPERTY INFORMATION Property Address Property Owner Name Property Owner Phone Number Property Owner Email Address Do you have a signed contract to reroof this property? It will need to be provided at the time of permit pick-up. 3780 Independence st Rick Sasser (303) 956-5181 Field not completed. Yes CONTRACTOR INFORMATION Contractor Name JB Masterbuilder Contractor's License 170143 Number (for the City of Wheat Ridge) Contractor Phone 303 324 5880 Number Contractor Email Address jared.jbmasterbuilder@gmail.com (permit pick-up instructions will be sent to this email) Retype Contractor Email jared.jbmasterbuilder@gmail.com Address DESCRIPTION OF WORK Is this application for a Yes new permit for a residential roof? Are you re -decking the No roof? Description of Roofing asphault shingles Material Select Type of Material: Asphalt If "Other" is selected Field not completed. above, describe here: How many squares of the 15 material selected above? Does any portion of the No property include a flat roof? If yes, how many squares Field not completed. on the flat roof? TOTAL SQUARES of all 15 roofing material for this proj ect 2 Provide additional detail home, 5/12 pitch, 1 layer here on the description of work. (Is this for a house or garage? What is the roof pitch? Etc) Project Value (contract 2500 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 Jared Searcy Email not displaying correctly? View it in your browser. 3 it C - 1}��',�ja t5r ,���.. �•�e:�_r�z ;-0 I'C(,,.1.-�-t i t..._;:q PREFERRED CONTRACTOR ,L�EENFpf / as MAW A MASTERBUILDER EErtei-ior R,wroi thyft ACCREDITED BUSINESS www.ibmasterbuilder.com Roofing — Painting — Siding — Gutters Office Phone: 720-532-0734 Licensed & Insured Insurance Restoration Specialists 1700 LIMA ST, UNIT qA Certified Inspectors AURORA, COLORADO 80010 Property Owner ("Owner") 5--6'_S ,y A Email 7, M ts!5 4 15—P; 4!a. C .. c e4ll Street ("The Property"] -� cityState�C Zip ��/ Cell Phone q! 1 S . - Home Other r Insurance Carrier: } Deductibles Claim# Roof Work Spedfications: Shingle Manufacturer' L -J amm no✓ �4c Type Of Shingle1i r'1 Shingle Lifetime 3_ color BVD C*— Tear off d Layer(s) of asphalt/shake/tile Shingles/Other SfieatR`Pn---77T6_ Install Felt KaSlb_301b Rhino Roof lcice & Water Shield to code- Pre -Existing? M[N] Claim Total Amount Esp@ated (RCV) Replacement Cost Value: Work Not Doing Upgrades First Payment: NATIVE 41 Total Payable to JBMASTERBUILDER' LL-; f'�k'^ +supplements' l+Demed�_uctible ^� Improvements in exchange for Insurance Scope, Breakdown and Supplemental Proceeds. :+Install Drip Edge to Code. - Pre -Existing? [Y][N] Color k4"X 11- 'Customer acknowledges that, after this agreement is signed, customers insurance carrier may approve a .%C6 nail pattern on the shingle (+20mph wind resist) supplement for additional materials/labors costs and additional requests not contemplated be customer and contractor when this agreement was signed. Customer agrees to promptly remit to contractor the amount of any /alleys will be Closed _Open --( (�, t �: i:j`g (�'^ "�'^ supplement paid by customers insurance carrier for such additional work carrier for such additional work performed ?3lnstall new pipe jack boots as needed k%�#% t*vii by or cost increases incurred by contractor. "„Install new vents as needed o Ing- YIC�T !�,Re-flash Wall Abutment as needed/if possible ;CTo Clean & Haul up all job related debris lw�=Magnetic Sweep of the yard for removal of nails L-5 year workmanship warranty ?-Estimated Date to begin the work � I _ Owner authorizes JB MasterBuilder ('Contractor") to contact the Owner's insurance company regarding damage to The Property. Owner understands that the Contractor will assist the Owner in obtaining appropriate property insurance damage adjustments, gaining approval of damage for repair and obtaining funds to repair Owner's Property. Owner authorizes Owners Insurance Company to discuss all matters directly with Contractor. Owner agrees to provide Contractor with any and all insurance information, claim number, insurance loss data and adjuster's report provided to the Owner by the Insurance Company pertaining the above Claim Number. Upon authorization of the Owners Insurance Company, for a price agreeable to the Contractor, Owner agrees that the Contractor shall perform work prescribed by the Insurance Company s loss data sheet, or adjusters report which includes the estimate of repair (RCIO as set forth in the insurers claim file plus any upgrades requested by the owner, or items necessary to pass inspection. First Insurance Check, and Deductible or 30% of RCV are due prior to ordering and scheduling of the work. See reverse side for all terms of agreement Special Instructions & Other Work Specifications: I Jt\r n \ Ailerrva e_i e Llf r1 ,'f-e'SlG �G� CG,e.r�� � f j ' � i/* t!;re, (.-t&e-5 We)'- tr'.p'�-;X' r'1 � � �'� i 'kHi'!a 4- Pr)4:tt ( � - tP %�^!R.?. e, it TA rc.fiq ' I'°-•rn owner is obligated to pay only the deductible required by the Owner's Insurance Company plus any upgrades requested by the owner. Owner further agrees to endorse insurance checks payable to the Contractor or to pay the contractor and equal amount." First Insurance Check & Deductible, or 30% of ACV are due prior to ordering and scheduling of the work, unless otherwise approved by management. Owner owes the Contractor nothing in the event the insurance Company does not authorize the repairs. Property Owner Aut rued Represe:�ntative of the CContractor es Date: p • Date: Date: Office: 303 - 235 -2855 * Fay: 303 -237-8929 Inspection Request ,i 1 303-234-5933 Building Permit Application (Couplets AH highlighted areas) fit i r n arl rr property ad dress) Address: MMMM ' (Fully describe work to rform - Attach additional sheet It necessary 1 yr t Al Rearlow Foe (due at 6" ofsvaartaatr 61: Squares,_.—,- BTU's Gallons Amps,__,___ Sq Ft 1 latreby c.sat it v that, the saaathaack dktanco lat'acla a s cl by thia Itc-mi t application are, atcc.aataaw and sla) not violate applicable ordin arwes, rules a. +r regulations of the, ( ity gal' Whea , t Ridge or covenants, a,aawa~aaassne, or restrictions (if recor(t that all a ataaaaaaarayrraents sltasastt and aalla„ °ggaataarsaaa trsaaalet are ,ascaarto , that 1 have aaaaaal aaaral a ree to a lay all Conditions priwed on this application and that 1 aaa aaatara« hall sa^alaaaarsibility fiat cofrip6ancc with applicable City of 'Wheat It €c3g ("'odes and ordinance" to s° as =ork Under ally laaasarsit i amaaaal haasa~al on this a alaplia~aasteara, that 1 data's the ic""aal aaca ncr or have l -asaaa autborimM by Hasa tee aa$ owner t° asl'the property rty tar la .t taaraoa the ala.9cr'slaa cl a rat and aatat aalwce aastlimizeNi by the lggaal a.avner of aatay aitfisty included on this kappls's,atscaaa its list that s,°aatity on than calrlalis at €era's, avre Bldg Valuation: City License City License # City License. »dy 0 . 11 " # 0 1 0 �Jgg"U, go tors City Lloonse #: Phone: OATE: q-1--a Q, A 4' City of Wheat Ridge rooolor Residential Roofing PERMIT - 09,0122 PERMIT NO: 090122 iISSUED:: 02/19/2009 JOB ADDRESS:.. 3780 INDEPENDENCE ST 'EXPIRES: 08/18/2009 DESCRIPTION:, T/O; install 15 sqs. 30 yr !dimensional shingles. CONTACTS owner 303/475-8200 Steve Kinney Bank owned / Remax gc 303/466-0161 Bernie Reitz 01-9543 Reitz Roofing, Inc.' PARCEL INFO ZONE (CODE: UA ..:USE: UA SUBDIVISION:` 0618 BLOCK/LOT#: 0/ FEE SUMMARY ESTIMATED PROJECT VALUATION: 3,150.00 FEES Permit Fee - 126.50 Total Valuation .00 Use :Tax 56.70 TOTAL IB3.20 3onditions: 5 nail installation mid-roof inspection required. Board sheeting spaced more then <a 1/4 of an inch apart requires plywood overlay on entire roof 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 Wheatt Ridge Building Code-(I.B.C) and all other applicable Wheat Ridge Ordinances, £or wor under this permit. Plans subject to field inspection. r ~/~~/off Signature of contr-actor/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 maybe granted at the discretion of the Building Official'. 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 changeshave beenor if suspension or abandonment 'exceeds one (1) year, full fees 'shall be jpaid for anew permit. 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., oFw"EgrRO City oflWheat Ridge Building Division thI Ave., Wheat Ridge, CO 80033 7500 W. 29 " Office: 303-235-2855 ~ Fax: 303-235-2857 a Inspection Liner 303-234-5933 Building Permit Application Property Address: 1~ dEy7f c/f~ es S Property Owner (please print) Phoneee dd ya resS) Mailing Address. (lfdlfferent than proper Address: City, State Zip: Contractor: We"-/-z Rf-A Contractor License Phone: _ 1-11 & - ©l e l Sub Contractors: Electrical City License Plumbing City License Mechanical City License Company: Company Company: Exp. Date: Exp. Date: Exp. Date: Approval: Approval: Approval: Use of space (description):. Construction Value: $ (as calculated per the Building aluation.Data sheet) Description ofwork: /O j A ,.,x > P4 "o 7e4 ;3 Plan Review (due at time of submittal): $ , - Sq. Ft./L.Ft added: Squares. BTU's t 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 Wheal Ridge Building Code (I.B.C) and all other applicable Wheat Ridge Ordinances, for work under this permit. Plans subject to field Inspection. CIRLCEONE:: (OWNER) (CONTRACTOR) or PERSONAL REPR TATIVEof aNECONTRATOR) PRINT NAME: 6"461- - Date:O~ I SIGNATURE: DEPARTMENT USE ONLY ZONING COMMENTS: Zoning: Reviewer: PUBLIC WORKS COMMENTS: Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: OCCUPANCY:- FIRE DEPARTMENT:: 0 approved w/ comments ❑ disapproved 0 no review required