HomeMy WebLinkAbout3460 Independence CourtCity of Wheat Ridge
Residential Electric PERMIT - 201702602
PERMIT NO: 201702602 ISSUED: 06/27/2017
JOB ADDRESS: 3460 Independence CT EXPIRES: 06/27/2018
JOB DESCRIPTION: Remove existing meter house and install new 200 amp meter (main combo panel
and elevate overhead lines with mast to meet 12 ft clearance from grade)
*** CONTACTS ***
OWNER (303)250-5029 REALE KATHRYN A
SUB (303) 928-0313 Bryan Peterson 17014?
*** 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: 2,250.00
FEES
Total Valuation 0.00
Use Tax 47.25
Permit Fee 93.35
** TOTAL ** 140.60
*** COMMENTS ***
53 3
*** CONDITIONS ***
Must comply w/ 2012 IRC & 2014 NEC. Subject to field inspection.
I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications.
applicable buil s, and all applicable municipal codes, policies and procedures, and that I am the legal owner or have been authonzud
by the le wrier ofth property and am authorized to obtain thispmermit and perform the work described and approved in conjunction with
this eranit. further a est that I am le ally authorized to include all entities named within this docuent as parties to the work to be
perfQfime and that wo be perform is disclosed in this docume and/ r its' accompanying approved plans and specifications.
Sign e of �r CONTRACTOR (Circle one) Dat
his permit was' ssued ase dZln-We`mformation provided in the permit application and accompanying plans and specificatinns and is
subject to Che 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 days made be granted at the discretion of the Chief Building
Official and may be subject to a fee equal to one-half of the originalpermit fee.
1 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 gra a permit shall t be os ued to be a permit for, or an approval of, an violation of any provision of any
applicable code or any rice or re is urisdiction. Approval of work is subject to f eld 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@ci.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.
I �_0�jfl
J.�O:WqJVKQqNSV'PECTION RECORD
NSPECTION ONLINE FORM: http://www.ci.wheatridge.co.us/forms.aspx?f0 d id=79
INSPECTION REQUEST LINE: (303) 234-5933
Occupancy/Type
9_f( `_(
Inspections will not be performed unless this card is posted on the project site.
Call the inspection request line before 11:59 p.m. to receive an inspection the following business day.**
Inspector Must Sign ALL Spaces pertinent to this project
Foundation Inspections
Date Inspector CommentsInitials
Pier
Electrical
Concrete Encased Ground (CEG)
Sewer Service
Foundation / P.E. Letter
I.
Do Not Pour
Concrete Prior 10 Approvall vT i ne muuve 111-p—,w, la
Underground/Slab Inspections
Date Inspector CommentsInitials
Electrical
Sewer Service
Plumbing
_. __ r■_�_._.n� 01-t. \Al 11 0riTn Arnval I IT I hP_ Anove Inspections
UO NOL lrOVel UIIUVI Ivullu v1
Rough Inspections
uu■w"1111-�•�--
Date
Inspector
Initials
- - ■-■- -
Comments
Wall Sheathing
Mid -Roof
Lath / Wall Tie
Rough Electric
Rough Plumbing/Gas Line
Rough Mechanical
Rough Framing
Rough Grading
Insulation
Drywall Screw / Nail
Final Inspections
Date
Inspector
Initials
Comments
Landscaping & Parking / Planning Dept.
Inspections from these entities should be requested
one week in advance. For landscaping and parking
inspections call 303-235-2846. For ROW and drainage
inspections call 303-235-2861. For fire inspections
contact the Fire Protection District for your project.
ROW &Drainage /Public Works Dept.
Floodplain Inspection (if applicable)
Fire Inspection / Fire Protection Dist.
Final Electrical
Final Plumbing
Final Mechanical
Roof
Final Window/Doors
Final Building
NOTE: All items must be completed and approved by Planning, Public Works, Fire and Building before a Certificate
of Occupancy is issued. Approval of the Final Building inspection does not constitute authorization of occupancy.
.—_i.....a 4:1- . +k. Ciro n;efrir4 �nrl alartrirnl inw voltage.
*For low voltage permits — rlease De sure uiai 1t,uy11 1n,3N",u■� a r, _ _.__. __ _
by the Building Division.
Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued
Protect This Card From The Weather
s
City of Wheat Ridge
Residential Electric PERMIT - 201702602
PERMIT NO: 201702602 ISSUED: 06/27/2017
JOB ADDRESS: 3460 Independence CT EXPIRES: 06/27/2018
JOB DESCRIPTION: Remove existing meter house and install new 200 amp meter (main combo panel
and elevate overhead lines with mast to meet 12 ft clearance from grade)
*** CONTACTS ***
OWNER (303)250-5029 REALE KATHRYN A
SUB (303)928-0313 Bryan Peterson
170142 Energy By Design 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: 2,250.00
FEES
Total Valuation 0.00
Use Tax 47.25
Permit Fee 93.35
** TOTAL ** 140.60
*** COMMENTS ***
*** CONDITIONS ***
Must comply w/ 2012 IRC & 2014 NEC. Subject to field inspection.
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 erm>t.Lfurth r attest that I am legally authorized to include ali entities named within this document as parties to the work to be
performed and t�► tall work to €r ora�ed is disclosed in this document and`or i "accomyanying approved plans and specifications.
Signdf re of" -OWNER= a -(eONTRACTOR (Ci'rgle one) Date / 1 `
I . 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 t os -g 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 days 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 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 perfonned 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, an violation of any provision of any
appltca, I�W,de or any ordinance or regulation of this jurisdiction. Approval of work is subject to field 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 insptimerequestgei.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.
City of
Wheat R I
COMMUNITY DEVELOPMENT
Building & Inspection Services Division
7500 W. 29th 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
FOR OFFICE USE ONLY
Date:
Plan/Pennit #
Plan Review Fee:
Building Permit Application
*** Please complete all highlighted areas on both sides of this form. Incomplete applications may not be
processed. ***
Property Address:
Owner
Property Owner
A(� L iol (2e� l e_ Phone: jo 3 2 So S-02
9
Mailing Address: (if different than property address)
Address:
City, State, Zip:
FA
Architect/Engineer:
Architect/Engineer E-mail: Phone:
i
Contractor:'
i3a � 4'Z ,E &313
Contractors City License #: � � L- Phone:
Contractor E-mail Address: /t P rG �/ . Co •tit
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
❑ RESDENTIAL 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.) ,1
ZCCA
Ve
�2 J
Sq. Ft./LF Btu's
Amps
Squares
Gallons
Other
Project Value: (Contract value or the cost of all materials and labor included in the entire project)
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. I, the applicant for this building permit application, warrant the
truthfulness of the information provided on the application.
CIRCLE ONE: (OWNER) (CONTRACTOR) or (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR)
Electronic Signature (first and last name): DATE: 2 l
ZONING COMMMENTS:
Reviewer:
BUILDING DEPARTMENT COMMENTS:
Reviewer:
DEPARTMENT USE ONLY
OCCUPANCY CLASSIFICATION:
Building Division Valuation: $
44, CITY OF WHEAT RIDGE
_��9rBuilding Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: 6 )C�,T:
-Job Address: - 111,6 0 T -n den en dewe c_( -
Permit
(-
Permit Number: 2V17 O 2- 6 ®d-
fD Y e
❑ No one available for inspection: Time _ 16) 63 60M
Re -Inspection required: (9 No
When corrections have been made, call forre-inspectionat 303-234-5933
Date: 7 / Inspector:
DO NOT REMOVE THIS NOTICE
j#
-7. iS
A i CITY OF WHEAT RIDGE
Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: L F )
Job Address: 3 &'l (00 f h-0
Permit Number: 2o 1 '70,? p
❑ No one available for inspection: Time5-69/10M
Re -Inspection required: Yes CN-o-�
When corrections have been made, call for re -inspection at 303-234-5933
Date: 717//7 Inspector: GA�
DO NOT REMOVE THIS NOTICE
C
' L)1100 39 —�l ECTION RECORD
^9
�_s INSPECTION REQUEST LINE: (303) 234-5933
Inspections will not be performed unless this card is posted on the project site.
Call the inspection request line before 11:59 p.m. to receive an inspection the following business day.**
Inspector Must Sign ALL Spaces pertinent to this project
Foundation Inspections Date Inspector Comments
Initials
Pier
Concrete Encased Ground (CEG)
Foundation / P.E. Letter
Do Not Pour Concrete Prior To Approval Of The Above Inspections
Underground/Slab Inspections Date Inspector Comments
Initials
Electrical
Sewer Service
Plumbing
Do Not Cover Underground or Below/In-Slab Work Prior To Approval Of The Above Inspections
Rough Inspections
Date
Inspector
Initials
Comments
Wall Sheathing
Mid -Roof
J
Lath / Wall Tie
Rough Electric "
Rough Plumbing/Gas Line
Rough Mechanical
Rough Framing
Insulation
Drywall Screw/ Nail
Final Inspections
Date
Inspector
Initials
Comments
Landscaping & Parking / Planning Dept.
Inspections from these entities should be requested
one week in advance. For landscaping and parking
inspections call 303-235-2846. For ROW and drainage
inspections call 303-235-2861. For fire inspections
contact the Fire Protection District for your project.
ROW & Drainage / Public Works Dept.
Fire Inspection / Fire Protection Dist.
Final Electrical
Final Plumbing
Final Mechanical
Roof%
Final Window/Doors
Final Building
NOTE: All items must be completed and approved by Planning, Public Works, Fire and Building before a Certificate
of Occupancy is issued. Approval of the Final Building inspection does not constitute authorization of occupancy.
*For low voltage permits — Please be sure that rough inspections are completed from the Fire District and electrical low voltage
by the Building Division.
"For Inspection Time Window Requests — Please email insptimerequest(o)ci.wheatridge.co.us by 8:00 A.M. the day of the
inspection with the property address in the subject line of the email.
Occupancy Is Not Permitted Until A Certificate of Occupancy Is Issued
Protect This Card From The Weather
i CITY OF WHEAT RIDGE
Building Inspection Division
(/ (303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
Inspection Type: A F,-
Job
rJob Address: � �j (. Q E �j 7 C. p e Xs r -s r N
Permit Number: 10 L7 6 6-3 9 3
Vr7 7 'r 6 Xj e 75
51�7- l,s Ll" vNn/C_2
4
O No one available for inspection: Time AM/PM
Re -Inspection required: Yes No
* When corrections have been made, call for re -inspection at 303-234-5933
kjDate:����� Inspector:
U
DO NOT REMOVE THIS NOTICE
i CITY OF WHEAT RIDGE
A Building Inspection Division
(303) 234-5933 Inspection line
(303) 235-2855 Office • (303) 237-8929 Fax
INSPECTION NOTICE
A
Inspection Type: M 1 D
�� t� �. p a c �'i
Job Address:
Permit Number: T R 3
Pr//6Ve o
❑ No one available for inspection: Time %O-' �rb AM/PM
Re -Inspection required: Yes No
* When corrections have been made, call for re -inspection at 303-234-5933
Date: Inspector: _
T
DO NOT REMOVE THIS NOTICE
City of Wheat Ridge
Residential Roofing PERMIT - 201700393
PERMIT NO: 201700393 ISSUED: 03/21/2017
JOB ADDRESS: 3460 Independence CT EXPIRES: 03/21/2018
JOB DESCRIPTION: Tear off old roof, put on new roof - 29 squares
*** CONTACTS ***
OWNER (303)912-6995 DOODY MARK
*** 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: 10,000.00
FEES
Total Valuation 0.00
Use Tax 180.00
Permit Fee 204.30
** TOTAL ** 384.30
*** 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 A1/2 -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€T"s 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'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.
I, the property owner, by my signature, attest that I currently reside at the project
property, intend to reside at the property for a period of one year after completion of the
project, and am personally performing all work, without the assistance of hired or
professional workers. Consultations and inspections will only be performed with the
homeowner of record present.
City of Wheat Ridge
Residential Roofing PERMIT - 201700393
PERMIT NO: 201700393 ISSUED: 03/21/2017
JOB ADDRESS: 3460 Independence CT EXPIRES: 03/21/2018
JOB DESCRIPTION: Tear off old roof, put on new roof - 29 squares
1, by n 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 ermit. I further attest that I am legally authorized to include all entities named within this document as pasties to the work to be
performed and tha�1 work to be performed is disclosed in this document and/or its' accompanying approved plans and specifications.
Signature of OWNER or CONTRA��OR (Circle one) Date
I , 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 days 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 penmit 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 an 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, an violation of any provision of any
applicable code ora" dina�n�cee,or regulation of t'hiss jurisdiction. Approval of work is subject to field 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@ci.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.
City of
W heat �jdge
COMMUNITY DEVELOPMENT
Building & Inspection Services Division
7500 W. 29th Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-237-8929
Inspection Line: 303-234-5933
Email: permits(cDci.wheatridge.co.us
FOR OFFICE USE ONLY
Date: � J
Plan/Permit #
Plan Review Fee:
Building Permit Application
*** Please complete all highlighted areas on both sides of this form. Incomplete applications may not be processed. ***
Property Address:
Owner
Phone:
Property Owner Email: M a d to : Q�I 10 t�1 C O vyk CCAS e �
Mailing Address: (if different than property address)
Address
City, State, Zip:
Architect/Engineer:
Architect/Engineer E-mail:
Contractor: SE `-
Contractors City License #:
Contractor E-mail Address:
Sub Contractors:
Electrical:
W.R. City License #
Other City Licensed Sub:
City License #
Plumbing:
W.R. City License #
Phone:
Phone:
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
❑ RESDENTIAL ADDITION ff 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.)
jest- (�--(c o ON ro ,�k� f u-� on n e- w)
Sq. FULF
Amps
Btu's ( Gallons
Squares 1 Other
Project Value: (Contract value or the cost of all materials and labor included in the entire project)
$ 10, U o
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. 1, the applicant for this building permit application, warrant the
truthfulness of the information provided on the application.
CIRCLE ONE: i �(OW�NER)0NTRACTOR) or (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR)
C
Electronic Signature (first and last name): DATE: 3
ZONING COMMMENTS:
Reviewer:
BUILDING DEPARTMENT COMMENTS:
Reviewer.
DEPARTMENT USE ONLY
OCCUPANCY CLASSIFICATION:
Building Division Valuation: $
Colorado
Comincrcica( Driver
Expires: 09-30-2019
issued: 09-15-2015
WB: 09-30-1957