HomeMy WebLinkAbout4590 Holland StreetFrom: no-reolvCalci.wheatridae.co.us
To: CommDev Permits
Subject: Online Form Submittal: PERMIT APPLICATION Sewer or Water Line Repair
Date: Wednesday, June 8, 2022 3:05:16 PM
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PERMIT APPLICATION Sewer or Water Line Repair
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 4590 Holland Street
Property Owner Name Scott Williams
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"
719-252-9506
williamswheatridge@gmail.com
Holland Street Electronic Payment Form.odf
CONTRACTOR INFORMATION
Contractor Business Sewer Lines Only, LLC
Name
Contractor's License 180100
Number (This is a 5 or
6 digit number for the
City of Wheat Ridge)
Contractor Phone 720-562-0128
Number (enter WITH
dashes, eg 303-123-
4567)
Contractor Email permits@sewerlinesonly.com
Address
Retype Contractor permits@sewerlinesonly.com
Email Address
01:K163CiIi1 ffl0N]avOLelS:/
Is this a sewer line or
Sewer Line
water line repair?
Length of repair
34 feet
Location of repair
Front Yard
(backyard, frontyard,
etc)
Provide additional
New line will be SDR35, new double sweep cleanouts will be
details including
installed
installation of clean -
outs.
Project Value (contract
7250
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 Kimberly Miller
Pe rm it
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