HomeMy WebLinkAbout202201462 - 4144 Balsam St - App_Page_1From: no-reolvCalci.wheatridae.co.us
To: CommDev Permits
Subject: Online Form Submittal: PERMIT APPLICATION Air Condiboner/Evaporative Cooler
Date: Thursday, June 30, 2022 6:25:33 AM
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PERMIT APPLICATION Air Conditioner/Evaporative Cooler
This application is exclusively for AIR CONDITIONER OR EVAPORATIVE
COOLER.
YOU MUST ATTACH THE ELECTRONIC PAYMENT FORM IN ORDER FOR
THE PERMIT TO BE PROCESSED.
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.
PROPERTY INFORMATION
Is this a new install or
replacement for an
existing AC unit?
Is this Residential or
Commercial?
Replacement of Existing Unit
Residential
Property Address 4144 Balsam St
Property Owner Name Marcie Sullivan
Property Owner Phone
Number (enter WITH
dashes, eg 303-123-
4567)
303-467-1622
Property Owner Email staff@lakesideheating.com
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
6 digit number for the
City of Wheat Ridge)
Contractor Phone
Number (enter WITH
dashes, eg 303-123-
4567)
Contractor Email
Address
Lakeside Heating & AC
303-421-3572
becky.b@lakesideheating.com
Retype Contractor becky.b@lakesideheating.com
Email Address
DESCRIPTION OF WORK
What type of Air Conditioner
replacement unit are
you installing?
How many tons is the
unit?
For AC - what is the
SEER?
For Evaporative
Coolers, what is the
CFMs?
2
11+'17
Where is the unit backyard
located (for example,
rooftop, backyard on
ground etc)?
Is electrical needed for Yes
re -hook?
Provide Electrical 202103
Contractor's Wheat
Ridge License No.
Project Value (contract 6100.00
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 Rebecca Buras
Pe rm it
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