HomeMy WebLinkAbout202201454 - 6017 W 40th Ave - App_Page_1From: no-reolvCalci.wheatridae.co.us
To: CommDev Permits
Subject: Online Form Submittal: PERMIT APPLICATION Sewer or Water Line Repair
Date: Wednesday, June 29, 2022 9:17:45 AM
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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 6017 W 40th Ave
Property Owner Name Jared Phifer
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"
(720)391-3574
Field not completed.
Electronic Payment Form .Ddf
CONTRACTOR INFORMATION
Contractor Business Junior Plumbing and Services
Name
Contractor's License 170088
Number (This is a 5 or
6 digit number for the
City of Wheat Ridge)
Contractor Phone (720)385-8923
Number (enter WITH
dashes, eg 303-123-
4567)
Contractor Email Juniorps645@gmail.com
Address
Retype Contractor Juniorps645@gmail.com
Email Address
0]:K16]CiIi1W0N]&TWO]S21
Is this a sewer line or
Water Line
water line repair?
Length of repair
35
Location of repair
Front yard
(backyard, frontyard,
etc)
Provide additional
Nia
details including
installation of clean -
outs.
Project Value (contract
1600
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 Humberto Armendariz Jr
Pe rm it
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