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PROJECT:
WESTRIDGE (YARROW GARDENS)
PHOTOVOLTAIC SYSTEM MASTER PLAN
BUILDER: THRIVE HOME BUILDERS
1875 LAWRENCE STREET, SUITE 900
DENVER, CO 80202
LOCATION: TRACT NUMBER BLOCK 26
WHEAT RIDGE, CO
ORIGINAL BY: DUSTIN CANNING
DATE: 19.02.21
i c
R
�€ 3
8�R
i0 OR
0 8 :CD,
xU�
REVIEWED BY: CHRISTINE MARTINI
DATE: 19.02.22
From: no-reolv(alci.wheatridae.m. us
To: CommDev Perm is
Subject: Online Form Submittal: Solar PV Installation
Date: Tuesday, March 23, 20212:27:31 PM
Solar PV Installation
This application is exclusively for Solar PV Installations
YOU MUST ATTACH A VALID ELECTRONIC PAYMENT ORM 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 Yes
Solar PV Installation?
PROPERTY INFORMATION
Property Address 7849 W 43rd Place
Property Owner Name Thrive Homebuilders
Property Owner Phone
Number (enter WITH
dashes, eg 303-123-
4567)
Property Owner Email
Address
Attach City of Wheat
Ridge Electronic
Payment Form - "DO
NOT ATTACH A
PICTURE OF A
CREDIT CARD"
3033194548
amarti@thrivehomebuilders.com
Electronic Payment Form.odf
CONTRACTOR INFORMATION
Contractor Business Namaste Solar Electric
Name
Wheat Ridge
Contractor's License
Number (This is a 5 or
6 digit number for the
090413
City of Wheat Ridge)
Contractor Phone 3034470300
Number (enter WITH
dashes, eg 303-123-
4567)
Contractor Email
kyle.pegon@namastesolar.com
Address
Retype Contractor
kyle.pegon@namastesolar.com
Email Address
DESCRIPTION OF WORK
Scope of Work
Master plan approved, over the counter permit. Installation of a
new 2.72 kw solar array on each individual unit of the Westridge
Yarrow Gardens community by Thrive Home Builders. Each
array will be totally independent of each other, but will have a
shared meter bank. Each solar array will be grid -tied, have no
battery connection, and will utilize enphase microinverters. We
will be installing Hanwha 340 watt solar panels and utilizing
unirac's racking system with the ecofasten roof attachment
system.
KW
2.72
# of Panels
8
Location of Panels
8 on roof
Structural required
No
Upload engineer letter
Westridae MPS AHJ_stam end ndf
or pages on 8 1/2" x
11" only
Solar Installation Plan
11X17 RFC PLOTPLAN WESTRIDGE LOT 10 7849 W 43rd
Set on 11"x17" only.
PLACE PLAN P2 EA -S OR 1 HW340.odf
Project Value (contract
6120
value or cost of ALL
materials and labor)
,A lei uG\ Lei :».]0111101.7A:Ra IF-a01.lnEel Ga01owmel:»:1r�d:10r1
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
has been issued and
posted on the property.
I certify that I have Yes
been authorized by the
legal owner of the
property to submit this
application and to
perform the work
described above.
Person Applying for Kyle Pegon
Permit
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.
Email not displaying correctly? View it in your browser.
� ► � i City of Wheat Ridge
Residential Solar PERMIT - 202100552
PERMIT NO: 202100552 ISSUED: 04/01/2021
JOB ADDRESS: 7849 W 43rd Pl EXPIRES: 04/01/2022
JOB DESCRIPTION: Master plan approved, over the counter permit. Installation of a new 2.72
kw solar array on each individual unit of the Westridge Yarrow Gardens
community by Thrive Home Builders. Each array will be totally independent
of each other, but will have a shared meter bank. Each solar array will be
grid -tied, have no battery connection, and will utilize enphase
microinverters. We will be installing Hanwha 340 watt solar panels and
utilizing unirac's racking system with the ecofasten roof attachment
system. 8 panels
*** CONTACTS ***
OWNER (303)205-8310 HDP WESTRIDGE LLC
SUB (303)447-0300 JEFF DENOVAN 090413 NAMASTE SOLAR ELECTRIC LLC
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2936 / SHARON MANOR / WESTPARK BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 61120.00
FEES
Total Valuation 0.00
Residential Solar 500.00
** TOTAL ** 500.00
*** COMMENTS ***
*** CONDITIONS ***
A printed copy of the permit and city stamped on-site plans must be available on-site for
the first inspection.
Approved per plans and red -line notes on plans. Must comply with 2018 IRC, 2020 NEC and all
applicable City of Wheat Ridge Municipal Codes. Work is subject to field inspections.
1* ► � i City of Wheat Ridge
'/� Residential Solar PERMIT - 202100552
PERMIT NO: 202100552 ISSUED: 04/01/2021
JOB ADDRESS: 7849 W 43rd Pl EXPIRES: 04/01/2022
JOB DESCRIPTION: Master plan approved, over the counter permit. Installation of a new 2.72
kw solar array on each individual unit of the Westridge Yarrow Gardens
community by Thrive Home Builders. Each array will be totally independent
of each other, but will have a shared meter bank. Each solar array will be
grid -tied, have no battery connection, and will utilize enphase
microinverters. We will be installing Hanwha 340 watt solar panels and
utilizing unirac's racking system with the ecofasten roof attachment
system. 8 panels
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�permrt. I further attest that I am leg ally authorized to include all entities named within this document as parties 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, 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 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 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 requ�ired
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, anviolation of any provision of any
�pplicabje code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection.
04/01/2021
Signature of Chief Building Official Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
VJAGW
A.G. WASSENAAR, INC.
Residential
2180 South Ivanhoe Street, Suite 5
Denver, CO 80222
Phone: (303) 759-8100
FIELD TICKET -Pending Review Report#: STL-000001
Client:
TH Yarrow LLC
1875 Lawrence Street, Suite 900
Denver, CO 80202
7849 W 43rd PI
Project: 202100094
185528-10R
7849 W 43rd PI, Lot 10, Block 3
Yarrow Gardens
Wheatridge, CO 000
FOUNDATION WALL REINFORCING OBSERVATION
Activity Date: 03/08/2021
Technician: Knauff, Stephen
As requested, we arrived on site on this date to observe the reinforcing steel within the foundation wall forms. It is our opinion that the
wall reinforcing steel we observed on this date was in general conformance with the project plans provided to us. It must be
understood that checking final form positioning is not within our scope of work. If you have any questions regarding this information,
please call. Observations were conducted on a part-time, on-call basis.
The Concrete Encased Electrode (CEE) was installed on this date at the following location(s):
5 Feet E Of NW Garage Corner
Observations are conducted on a part-time, on-call basis (unless noted otherwise). This field report should NOT Page 1 of 1
be considered a final report since it must be reviewed by the engineer. Therefore, all information within this report
and attachments (if any) are subject to review.
♦ i CITY OF WHEAT RIDGE
Building Inspection Division
(303) 235-2855 Office
INSPECTION NOTICE
Inspection Type: I'V 4 & C'�
Job Address: 7!Z' -/ ? Liz
Permit Number: 2- 0- a Q C� y
❑ No one available for inspection: Time AM/PM
Re -Inspection required: Yes . No
When corrections are complete, schedule re -inspection online.
Date: Inspector:
DO NOT REMOVE THIS NOTICE
♦ ®� ® CITY OF WHEAT RIDGE
Building Inspection Division
(303) 235-2855 Office
INSPECTION NOTICE
Inspection Type: F 67 V 7 --
Job
Job Address: 7 !L4'
Permit Number: -Ai' 2J 67
I
i
i
r
❑ No one available for inspection: Time '"g `'-/PM
r
Re -Inspection required: YeV ` No
I
When corrections are complete, schedule re -inspection online. I
a
Date: A ` Z Inspector:
DO NOT REMOVE THIS NOTICE
A.G. WASSENAAR, INC.
Residential
2180 South Ivanhoe Street, Suite 5
Denver, CO 80222
Phone: (303) 759-8100
FIELD TICKET -Pending Review
17849 W 43rd PI
202100094
Client:
TH Yarrow LLC
1875 Lawrence Street, Suite 900
Denver, CO 80202
Project:
Report #: EF -000001
185528-10R
7849 W 43rd PI, Lot 10, Block 3
Yarrow Gardens
Wheatridge, CO 000
EXCAVATION AND FOOTING FORM OBSERVATIONS
Activity Date: 03/01/2021
Technician: Retoff, John
As requested, excavation and footing form observations were performed on this date for the subject lot. The soils exposed at the current
grades during our visit appear generally consistent with those found and logged in the subject soil report. It is our opinion the bearing
pressures provided in the subject soil report can be used for the recommended foundation system. It is also our opinion that the
footing forms, foundation void (if required), and reinforcement (if required) we observed on this date were placed in general
conformance with the project plans provided to us and our recommendations. If you have any questions regarding this information,
please call. Observations were conducted on a part-time, on-call basis.
Observations are conducted on a part-time, on-call basis (unless noted otherwise). This field report should NOT Page 1 of 1
be considered a final report since it must be reviewed by the engineer. Therefore, all information within this report
and attachments (if any) are subject to review.
City of Wheat Ridge
Single Family New PERMIT - 202100094
PERMIT NO: 202100094 ISSUED: 02/17/2021
JOB ADDRESS: 7849 W 43rd Pl EXPIRES: 02/17/2022
JOB DESCRIPTION: Yarrow Gardens - New single family townhome with 2 car attached garage -
1,310 sq ft total (Model P2 -E)
*** CONTACTS ***
OWNER (303)205-8310
HDP WESTRIDGE LLC
GC (303)707-4422
GENE W. MYERS
180370 THB WESTRIDGE LLC
SUB (720)315-0364
GLENN CARRIZALES
130249 ULTRA ELECTRIC INC.
SUB (303) 761-9276
CHRISTOPHER REISTER
170100 STEEL T HEATING, INC.
SUB (303)978-1051
TODD WOODFORD
070071 C&T PLUMBING LLC
SUB (303)430-1414
SITEWISE LLC
202034 SITEWISE LLC
*** PARCEL INFO ***
ZONE CODE:
UA / Unassigned
USE: UA / Unassigned
SUBDIVISION CODE:
2936 / SHARON MANOR
/ WESTPARK
BLOCK/LOT#: 0 /
*** FEE SUMMARY ***
ESTIMATED PROJECT VALUATION: 191,250.00
FEES
Total Valuation
0.00
Plan Review Fee
120.00
Use Tax
41016.25
Permit Fee
11725.45
Engin. Review Fee
50.00
** TOTAL **
51911.70
*** COMMENTS ***
*** CONDITIONS ***
All roughs to be done at Framing Inspection.
A printed copy of the permit and city stamped on-site plans must be available on-site for
the first inspection.
Approved per plans and red -line notes on plans. Must comply with 2018 IRC, 2020 NEC and all
applicable City of Wheat Ridge Municipal Codes. Work is subject to field inspections.
No C.O. may be issued until public improvements are complete as identified in the
Subdivision Improvement Agreement.
All landscaping shall be installed in accordance with the approved landscape plan (Case No.
WSP-20-03) prior to C.O. and pursuant to the phasing identified in the Subdivision
Improvement Agreement. Per the SIA, installation of landscaping, street trees, and
irrigation is not required prior to Certificate of Occupancy if issuance of the C.O. occurs
outside of the planting season, generally October to June.
PERMIT NO:
JOB ADDRESS:
JOB DESCRIPTION:
City of Wheat Ridge
Single Family - New PERMIT - 202100094
202100094 ISSUED:
7849 W 43rd Pl EXPIRES:
Yarrow Gardens - New single family townhome with
1,310 sq ft total (Model P2 -E)
02/17/2021
02/17/2022
2 car attached
garage -
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�permrt. I further attest that I am leg ally authorized to include all entities named within this document as parties 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, 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 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 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 requ�ired
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, anviolation of any provision of any
�pplicabje code or any ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection.
02/17/2021
Signature of Chief Building Official Date
REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY.
no change to valuation
From: no-reolv(alci.wheatridae.m. us
To: CommDev Farm is
Subject: Online Form Submittal: New Single -Family TOWNHOME UNIT
Date: Thursday, 3anuary 14, 202110:49:22 PM
New Single -Family TOWNHOME UNIT
THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN
WORK UNTIL PERMIT HAS BEEN ISSUED.
Has the Master Plan
been approved for this
project?
Name of Project
Yes
3 Plex 10-12 Blk 3, Filing #4
PROPERTY INFORMATION
Property Address - 7849 W 43rd PI
Only enter one unit on
this application
Property Owner Name THB Westridge LLC
Property Owner Phone 303-766-7772
Number (enter WITH
dashes, eg 303-123-
4567)
Property Owner Email dvonfeldt@thrivehomebuilders.com
Address
PLAN REVIEW CONTACT INFORMATION
What Is your role? Owner, General Contractor
Business Name THB Westridge LLC
Main Contact Name for Deia Vonfeldt
Plan Review
Contact Phone Number
(enter WITH dashes,
eg 303-123-4567)
Contact Email Address
for
Questions/Comments
303-766-7772
dvonfeldt@thrivehomebuilders.com
Retype Contact Email dvonfeldt@thrivehomebuilders.com
Address
DESCRIPTION OF WORK
Detailed Scope of
Work - Example: New
single family townhome
with 2 car garage -
1,525 sq ft total (Bldg
1, B -unit)
New SF TH-2 car attached garage-P2E-1310 Sq ft -
Square Footage of 1310
New Construction
Foundation Plans for
Specific Building
Elevations of Building
Site Plan showing Unit
Highlighted
Floor plan of Unit
Construction Plans
scanned on 11'x17" or
larger
Project Value (contract
value or cost of ALL
materials and labor)
7849 W 43rd PI.Foundation Plans.ndf
7849 W 43rd PI. Arch Plans.ndf
7849 W 43rd PI.Soil Renort .odf
$191,250 okbf2/5/21
SIGNATURE OF UNDERSTANDING AND AGREEMENT
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.
I understand that work
may not begin on this
property until a permit
has been issued and
posted on the property.
Yes
Yes
I certify that I have
been authorized by the
legal owner of the
property to submit this
application and to
perform the work
described above.
I attest that everything
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
Permit
Yes
Yes
Deia Vonfeldt
VED
J. Jefferies
1/19/2021
Email not displaying correctly? View it in your browser.
Dept
City of Wheat Ridge
Residential Fire Sprinkler PERMIT - 202000303
PERMIT NO: 202000303 ISSUED: 02/11/2020
JOB ADDRESS: 7849 W 43rd Pl EXPIRES: 02/10/2021
JOB DESCRIPTION: Install new NFPA 13D fire sprinkler system
*** CONTACTS ***
OWNER (303)421-7515 THB WESTRIDGE LLC
SUB (303)389-9910 DWON LEWIS
060106 EXTREME FIRE PROTECTION CO.
*** PARCEL INFO ***
ZONE CODE: UA / Unassigned USE: UA / Unassigned
SUBDIVISION CODE: 2936 / SHARON MANOR / WESTPARK BLOCK/LOT#: 0 /
*** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 3,750.00
FEES
Total Valuation 0.00
Use Tax 78.75
Permit Fee 109.20
** TOTAL ** 187.95
*** COMMENTS ***
*** CONDITIONS ***
Approved per plans and red -line notes on plans. Must comply with 2012 IRC, 2017 NEC and all
applicable City of Wheat Ridge Municipal Codes. Work is subject to field inspections.
I, by my signature, do hereby attest that the work to be performed shall comply with all accompanyingg approved plans and specifications,
applicable building codes, and all applicable municipal codes, policies and procedures, and that I am t1�e 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 furth est that -am ally authorized to include all entities named within this document as parties to the work to be
performed tall work d be er o is disclosed in this document and/or its' accompanying approved plans and specifications.
Signature of OWNER or TOR (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 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 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, any violation of any provision of any
applicable codelw.4ny 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.
City of
YY h6alt f1�E'
COMMUN Tx D vELOPMENT
Building & Inspection Services
7500 W. 291 Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 * Fax: 303-237-8929
Inspection Line: 303-234-5933
Email: ermits(cci.tiivheatridge.co.us
FOR OFFICE USE ONLY
Date:
Plan/Permit # � i1
Plan Review Fee:
Building Permit Application
*** Complete all applicable highlighted areas on both sides of this form.
Incomplete applications may not be processed. ***
�y �L
Property Address:
Property Owner (please print): V
dam .
Phone: 369,,-
767•= 44,35-
43 -Property
PropertyOwner Email:
Tenant Name (Commercial Projects Only)
Property Owner Mailing Address: (if different than property address)
Address: 16-7 5} Z4.t-J54,+c-
City,
��
City, State, Zip: �
6C> 6 Ccs
Architect/Enaineer: 6-�2c/4/6'-'L�
v
Architect/Engineer E-mail: I Phone: ---1 'x'43 7
Contractor Name: lt4 6 AeeeffibtJ
City of Wheat Ridge License M 6 & l d O Phone: 3:,�9 - q 9l b
Contractor E-mail Address: �t s� 1- e 6e z'c� m a 10 "AA
For Plan Review Questions & Comments (please print):
CONTACT NAME (please print): h Or,C:) -S _Phone: _ P3 ----3 ` q— _ f
CONTACT EMAIL(please print): S(eA�A�-() L- P C -it f4L IAAF--r-1p a CDiw---
Sub Contractors (Must provide Wheat Ridge License No & Signed Subcontractor Authorization form):
Electrical: Plumbing: Mechanical:
W.R. City License # W.R. City License # W.R. City License #
Other City Licensed Sub: Other City Licensed Sub:
City License # City License #
Complete all highlighted fields, if applicable.
❑COMMERCIAL
C�ESIDENTIAL
Provide description of work: For ALL projects, 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.
Sq. FULF
BTUs
Gallons
Amps squares For Solar: KIN # of Panels Requires structural
For Commercial Projects Only: Occupancy Type: Construction Type:
Occupancy Load: Square Footage: _
Project Value: (Contract value or the cost of all materials and labor included in the entire project)
75-0
OV"'NERICONTRACTOR 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.
CIRCLEONE: (OWNER) (CONTRACT ) or (A�UTHO ED REPRESENTATIVE) of (OWN/ER) (CONTRACTOR)
Signature (first sod last name): ��LJ C �_ DATE: / . ` 2(?, Z�� ZC�
Printed Name: c5N 4o
ZONING COMMMENTS:
Reviewer:
BUILDING DEPARTMENT COMMENTS:
Reviewer:
PUBLIC WORKS COMMENTS:
Reviewer:
DEPARTMENT USE ONLY
OCCUPANCY CLASSIFICATION:
CONSTRUCTION TYPE:
Building Division Valuation:
I