HomeMy WebLinkAbout4727 Dudley StreetFrom: no-reolvCalci.wheatridae.co.us
To: CommDev Permits
Subject: Online Form Submittal: PERMIT APPLICATION General
Date: Wednesday, April 27, 2022 10:31:14 AM
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PERMIT APPLICATION General
This application is exclusively for Scopes of Work that do not already have a
specific form.
YOU MUST ATTACH AN ELECTRONIC PAYMENT FORM IN ORDER FOR THE
PERMIT TO BE PROCESSED.
THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN
WORK UNTIL PERMIT HAS BEEN ISSUED.
PROPERTY INFORMATION
Is the property Residential
Residential or
Commercial?
Property Address 4729 dudley street wheat ridge co 80033
Property Owner Name Brent Brewster
Property Owner Phone 720-387-1486
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"
CONTACT INFORMATION
Submitting General
Contractor or Architect
Contractor's License
brentwbrewster@gmail.com
Brent Brewster
Number (This is a 5 or
6 digit number for the
City of Wheat Ridge)
Contract Phone 720-387-1486
Number (enter WITH
dashes, eg 303-123-
4567)
Contact Email Address brentwbrewster@gmail.com
Retype Contact Email brentwbrewster@gmail.com
Address
Check the appropriate Plumbing
boxes if the following
work is involved in the
project.
Plumbing Contractor Brent Brewster
Name
Plumbing Contractor Field not completed.
License Number (This
is a 5 or 6 digit number
for the City of Wheat
Ridge)
Are there any
No
ADDITIONAL Sub
Contractors associated
with this project?
DESCRIPTION OF WORK
Detailed Scope of
Tying in back yard irrigation system to existing home water lines,
Work - Provide a
running new line outdoors, installing backflow vacuum preventer
detailed description of
work including
mechanical, electrical,
plumbing work
occurring,
adding/removing walls,
etc.
Square footage of
100
scope of work
Location of work
backyard, crawl space beneath house
(backyard, on roof, etc)
Project Value (contract
$147.00
value or cost of ALL
materials and labor)
Upload Engineer letter
Field not completed.
Upload Asbestos
Field not completed.
Report if triggler level is
met per CDPHE
regulation.
Upload Drawings
Backflow Diaaram.ipea
Upload Additional
Field not completed.
Drawings
Upload Additional
Field not completed.
Drawings
Upload Additional
Field not completed.
Drawings
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 Brent Brewster
Pe rm it
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