HomeMy WebLinkAbout202201448 - 9492 W 36th Ave - Application_Page_1City of
Wh'atf dge
COAAytir NiT1' DEVELOPMENT
Building & Inspection Services
7500 W. 29th Ave., Wheat Ridge, CO 80033
Office: 303-235-2855 ' Fax: 303-237-8929
Inspection Line: 303-234-5933
Email: permits _ ci.wheatridge.co.us
FOR OFFICE USE ONLY I
Date: G /;4/ gL
Plawpermit #-�' V o I L L,
Plan Review Fee: $a' q J,5
Building Permit Application
**' Complete all applicable highlighted areas on both sides of this form.
Incomplete applications may not be processed. ***
Property Address: 'qU f i) 3C-,,T1*A %L iA)L*:�t! / �r CO "a `5"
Property Owner (please print): ��t�l-�y l- / Phone:--9LZO -Z-7L/-5,3
Property Owner Email: _ _,� �r� 1 i' u
r
Tenant Name (Commercial Projects Only)
Property Owner Mailing Address: (if different than property address)
Address: 0 MC 1 C1917� -
City, State, Zi :;;;,sC.d CO - �0'4 T
Arc ItecJJEngineer7
Arch itect/Eng 1 neer E-mail:
Phone:
Contractor Name: ` OH H - 7- C -n
City of Wheat Ridge License #: 1306-� Phone: l _ LZ
Contractor E-mail Address: S; � ado w. J-�ye"ic —'D mak' wry-,_ -
For Plan Review Questions & Comments (please print): l i
CONTACT NAME (please print): � 7 1 � / ►�/ Phone: - l �
CONTACT EMAIL(please print): v )"'daJ ly ('
Sub Contractors (Must `p✓rovide Wheat Ridge License No & Signed Subcontractor Authorization form):
Electrical: J<FA�� 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 ARfRESIDENTIAL
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.
LJIU ZT
Sq. FULF z 1 e:90 BTUs 2 Gallons
Amps _. Squares For Solar: ICVY , # 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)
$ " �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. 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)
Signature (first and last name): DATE: Z-�
Printed Name:
ZONING COMMMENTS:
Reviewer
BUILDING DEPARTMENT COMMENTS:
Reviewer:
PUBLIC WORKS COMMENTS:
Reviewer.
DEPARTMENT USE ONLY
OCCUPANCY CLASSIFICATION:
CONSTRUCTION TYPE:
Building Division Valuation: