HomeMy WebLinkAbout4340 Oak StreetCity of
W heat f dge
COMMUNITY DEVELOPMENT
Building & Inspection Services Division
7500 W. 29" Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-237-8929
Inspection Line: 303-234-5933
Email: perm its(a)ci.wheatridge.co.us
I FOR OFFICE USE ONLY I
Date:
2,b/�b/c/o
Plan/PenPA' D
Plan R(Cpr3oi3<�/
en�+ew ree:
Building Permit Application
*** Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. ***
Property Address: J-340 OW,- S- -
Property Owner (please print): �ZQ b J 0.0 O bQ, Phone: 3 c�, 3 V 2`f 5) 5 Z
Property Owner Email:
Mailing Address: (if different than property address)
Address:
City, State, Zip:
Architect/Engineer:
Architect/Engineer E-mail:
Contractor: Tv�-e el A".e p� p -e "V�>
Contractors City License #:
Phone:
Phone: 10 � `&'I S 5 3 0)
Contractor E-mail Address: a elite Pt o e mCk . CoM
Sub Contractors:
Electrical:
W.R. City License #
Other City Licensed Sub:
City License #
Plumbing:
W.R. City License #
Other City Licensed Sub:
City License #
Mechanical:
W.R. City License #
Complete all information on BOTH sides of this form
❑ COMMERCIAL ❑ RESIDENTIAL
Description of work: (Check all that apply)
❑ NEW COMMERCIAL STRUCTURE ❑ ELECTRICAL SERVICE UPGRADE
❑ NEW RESIDENTIAL STRUCTURE ❑ COMMERCIAL ROOFING
❑ COMMERCIAL ADDITION ❑ RESIDENTIAL ROOFING
❑ RESIDENTIAL ADDITION ❑ WINDOW REPLACEMENT
❑ COMMERCIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.)
❑ RESIDENTIAL ACCESSORY STRUCTURE (Garage, shed, deck, etc.)
❑ MECHANICAL SYSTEM/APPLIANCE REPAIR or REPLACEMENT
PLUMBING SYSTEM/APPLIANCE REPAIR or REPLACMENT
❑ ELECTRICAL SYSTEM/APPLIANCE REPAIR or REPLACEMENT
❑ OTHER (Describe)
(For ALL projects, please provide a detailed description of work to be performed, including current use of areas,
proposed uses, square footage, existing condition and proposed new condition, appliance size and efficiency, type and
amount of materials to be used, etc.)
\Ni11 be �xCCL a
�arcl J -o PQrform Sewer r-e?Qk- S w -e wkMS-FCk
-two wad clean outs.
Sq. FULF i 0 Btu's
Amps
Squares
Gallons
Other
Project Value: (Contract value or the cost of all materials and labor included in the entire project)
$—LO -00. 00
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 applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application; that I am the legal owner
or have been authorized by the legal owner of the property to perform the described work and am also authorized by the legal owner of any
entity included on this application to list that entity on this application.
CIRCLE ONE.- (OWNER) ONTRACT or (AUTHORIZED REPRESENTATIVE) ^of,�(OWNER) (CONTRACTOR)
PRINT NAME: �1� kZkk-e 9— I SS -,— I `SIGNATURE�)vIA�J�XX. SAA -DATE: ko ► 3 l �o
ZONING COMMMENTS:
Reviewer:
BUILDING DEPARTMENT COMMENTS:
Reviewer:
PUBLIC WORKS COMMENTS:
Reviewer:
PROOF OF SUBMISSION FORMS
Fire Department ❑ Received ❑ Not Required
Water District ❑ Received ❑ Not Required
Sanitation District ❑ Received ❑ Not Required
DEPARTMENT USE ONLY
OCCUPANCY CLASSIFICATION:
TYPE OF CONSTRUCTION:
SPRINKLERED:
OCCUPANT LOAD:
Building Division Valuation: $