HomeMy WebLinkAbout4586 Field Streetf
lee
duation
I
of 'Wheat Ridge
.y w/ 2003
City of
Date: -7131o q
~?P Wheatj~idge
COMMUNITY DEVELOPMENT Permit#:[~~/08~~
---Building-Di-vision -
7500 W. 29th Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-235-2857
Inspection Line: 303-234-5933
Building Permit Application
Property Owner (please print): f~j r'Il l Z fJa-~~Y Phone:
Mailing Address: (if different than property address)
Address: tj H ~l
City, State, Zip:
~e vvi~2 ~lt c rr l bi n G fit 1
90twti C: t-W79
Contractor License Q Phone: 3 f yZ `a- O's q
Company Name: License Expiration Date: Trade/Profession: Approval:
Use of_~sppace description):
Tit'' f S W et Construction Value, $ 00
Plan. Review (due at time of submittal): $
Sq. Ft./L`.)Ftadded: 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 l 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.
CIRLCEONE:: (OWNER) ((CONTRACTOR) ERSONALREPRES~NTATIVEWNERATOR)
PRINT NAME: ✓G SIGNATURE:-y ,Date:Z D~
Credit Card P yment: Use credit Bard listed on file. Date: `7
Print name: aA 6/1 vii Signature: r,~zz ~