HomeMy WebLinkAboutState of Colorado-Defered InspectionsCOLORADO
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Building Department Representitive Printed Name d TV
Building Department Representitive Signature
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Title C4�ult_Dt►sG.- Cs�'rtGl/t—
Date 57-15- X
11 Accept �4 Defer Inspection
If applicable:
Fire Safety Official Printed
JULY2023
Contact email: �i.kM+O Q
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Fire Safety Official Signature Da
Contact email:
Is a fire protection system required? (check one) Required Not Required
If required, the inspection is to be performed by (check one):
Fire Department: (NAME
OR
Colorado Division of Fire Prevention Et Control
Manufacturer's Authorized Quality Assurance Representative
Printed Name Ken Brower
Manufacturer's Authorized Quality Assurance Representative
Signature KeiA. Brows Date 01 /09/2025
Contact email: ken.brower@cavco.com
If the inspection has been deferred and the manufacturer elects to utilize an Approved Third Party
Agency to inspect the "OC" items on behalf of DOH, please sign and date below.
Approved Third Party Agent Printed Name Mike Faller
Approved Third Party Agent Signature A&4, Fa&,, Date 01/09/2025
Contact email: mfaller@icc-nta.org
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