HomeMy WebLinkAbout3272 TellerFrom: no-reolv(alci.wheatridae.m. us
To: CommDev Pets
Subject: Online Form Submittal: Furnace/Boiler Replacement Permit Application
Date: Monday, November 8, 2021 10:13:09 AM
Furnace/Boiler Replacement Permit Application
This application is exclusively for RESIDENTIAL REPLACEMENT FURNACE or
BOILER - LIKE FOR LIKE ONLY.
YOU MUST ATTACH A VALID CREDIT CARD AUTHORIZATION FORM 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 a Yes
replacement residential
furnace or boiler like for
like?
PROPERTY INFORMATION
Is this Residential or Residential
Commercial?
Property Address 3272 Teller St
Property Owner Name
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"
Tim Baca
303-239-8101
timbaca@earthlink.net
CONTRACTOR INFORMATION
Contractor Business Bear Mountain Mechanical
Name
Contractor's License 190363
Number (This is a 5 or
6 digit number for the
City of Wheat Ridge)
Contractor Phone
303-674-3349
Number (enter WITH
dashes, eg 303-123-
4567)
Contractor Email
bearmountainmechanical@hotmail.com
Address
Retype Contractor
bearmountainmechanical@hotmail.com
Email Address
DESCRIPTION OF WORK
What type of unit is
Boiler
being installed?
Number of BTUs
34000
What is the efficiency
80
(%) of the unit?
Is the unit GAS or
Gas
ELECTRIC?
Where is the furnace or
crawlspace
boiler located (for
example, basement,
crawlspace, etc)?
Project Value (contract
$26,300
value or cost of ALL
materials and labor)
SIGNATURE OF UNDERSTANDING AND AGREEMENT
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.
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.
Person Applying for shallyn Watson
Permit
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