HomeMy WebLinkAbout202201523 - 4480 Pierce St - APPCity of
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Building & Inspection Services
7500 W. 29A Ave.. Wheat Ridge. CO 80033
Office: 303-235-2855 ` Fax: 303-237-8929
Inspectlon Une: 303-234-5933
Email: oermitsfdci.whealndge.co.us
FOR OFFICE USE ONLY
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Building Permit Application
Complete all applicable highlighted areas on both sides of this form.
Incomplete applications may not be processed.
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Property Owner (please print); rrL
�Nd u/ swa< Phone: 36
Property Owner Email:
Tenant Name (Commercial Projects Only)
Property Owner Mailing Address: f f a/flerent than property address)
City, State, Zip:
Architeef/Enginesr Ercall: Phe
Contractor Name:
City of Wheat Ridge License #: 0022. 16 O Phoria: I1- d Y Z 9S
Contractor Enall Address: 1) �'� �e Q✓/, LO 'Ary
For Plan Review Questions & Comment& (please print): p U �y
CONTACT NAME (please pdnt):J�ea� J/��'U'�cr Phone: 7L4'L7/-
CONTACT EMAIL(please print):46 on
Sub Contractors (Must provide Wheat Ridge License No & Signed Subcontractor Authorization form):
Eledncel: Plumbing: Mechanical:
W.R. City License# W.R. City License# W.RCiry License#
OMer City Licensed Sub: OMer City Licensed! Sub:
City license 0 City License #
Complete all highlighted fields, if applicable.
❑COMMERCIAL (RESIDENTIAL
Provide description of worK: For ALL projects, provide a detailed description or wOrK to De
performed, including current use of areas, proposed uses, square footage, existing condition and
proposed feel necondition, appliance size and efficiency, type and amount of materials to be used, etc.
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Sq. FULF BTUs Gallons
Amps SquengFor Solar: Irw sfsemr_Rpdmaswduml
For Commercial Projects Only: Occupancy Type: _ Construction Type:
Occupancy Load: Square Footage:
rrapolVsem:consisted value orMe cont dllLmetpdaln and alder Ireadel In Me entlre pmlecl)
ORTBR NTRA R SIGNATORR OF UNDERSTANDING ANe AGREEMENT
1 bv<by ee ady Met Me sathack diseases proposed by this remtit application an aenurue and m nor viokte applieabk wMirences, rules of
,eguvreans of nor city of Vitro Ridge or covmers,euem<nD or matrons of record; that all m and mre
te;threat and allegations argue a
,safeet I]save coed ad agree to aball stable by conditions rooted on this application and that l eryume full orepondbility for compliance,
were applicable City of enter Ridge coder are ordinances for work under any pnmil tamed based on dos application; that I am the legal sever
or Nye bean audeeriad by the legal woven of The property to pufonn the dreenti work end an also auMorittd by the legal owner of my
CIRCLE ONE: ® all ID or rMSEATATIVEI f ndR �¢¢Qvv,,vvyyuucrojo
e, cwmgratam! k Den: 7/ " `627
rdatd Name: J o,&ods, ar
DEPARTMENT USE ONLY
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Building Division Veluetlon: