HomeMy WebLinkAbout5785 W 32nd AvenueFrom: u2mossad ylici neoe a J:
To: Onul Penn!
sWjett Online Fmm Sunni PEPMIT APNCATDON sever or Water One Repair
Dai today, Mardi 4,202211:24:01 AM
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PERMIT APPLICATION Sewer or Water Line Repair
This application is exclusively for SEWER OR WATERLINE 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 pearl 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 5785 w 32nd Ave
Property Owner Name Mag Builders
Property Owner Phone 7576,122831
Number (enter WITH
dashes, eg 303-123-
4567)
Property Owner Email Field not completed.
Address
Attach City of Wheat ElectmnirAaymant-Form Si W 32nd Avg nor
Ridge Electronic
Payment Form - "`DO
NOT ATTACH A
PICTURE OF A
CREDIT CARD"
CONTRACTOR INFORMATION
Contractor Business Untied Plumbing
Name
Contractor's License
100264
Number (This is a 5 or
6 digit number for the
City of Wheat Ridge)
Contractor Phone
7204223167
Number (enter WITH
dashes, eg 303-123-
4567)
Contractor Email
unite plmg@mmcast.net
Address
Retype Contractor
uniteciplmg@mmcast.net
Email Address
DESCRIPTION OF WORK
Is this a sewer line or
sewer Line
water line repair?
Length of repair
115,
Location of repair
Front Yard and sidewalk
(backyard, frontyard,
etc)
Provide additional
dobre set of clean outs whit tracing wire
details including
installation of clean -
outs.
Project Value (contract
500
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 Zuleycollins
Permit
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