HomeMy WebLinkAbout4141 Depew StreetFrom: no-reolv(alci.wheatridae.m. us
To: CommDev Pets
Subject: Online Form Submittal: Sewer or Water Line Repair Permit Application
Date: Monday, November 1, 20215:35:28 PM
Sewer or Water Line Repair Permit Application
This application is exclusively for SEWER OR WATER LINE REPAIR - IN YARD
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.
Right of Way permits must be applied for with the Public Works Department.
Is this application for Yes
sewer line or water line
repair - in yard only?
PROPERTY INFORMATION
Is this Residential or Residential
Commercial?
Property Address 4141 Depew St
Property Owner Name
Property Owner Phone
Number (enter WITH
dashes, eg 303-123-
4567)
Pamela Womack
19118YAW-001-3
Property Owner Email Field not completed.
Address
Attach City of Wheat
Ridge Electronic
Payment Form - "DO
NOT ATTACH A
PICTURE OF A
CREDIT CARD"
CONTRACTOR INFORMATION
Contractor Business
Name
Contractor's License
Number (This is a 5 or
Pipeline Solutions LLC
ipillVil
6 digit number for the
City of Wheat Ridge)
Contractor Phone
3038105321
Number (enter WITH
dashes, eg 303-123-
4567)
Contractor Email
denpermits@gmail.com
Address
Retype Contractor
denpermits@gmail.com
Email Address
DESCRIPTION OF WORK
Is this a sewer line or
sewer Line
water line repair?
Length of repair
40
Location of repair
backyard
(backyard, frontyard,
etc)
Provide additional
set of dual directional cleanouts
details including
installation of clean-
o uts.
Project Value (contract
5280
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 Jose Guerrero
Permit
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