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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 53M Pierson Cl
Property Owner Name Mat Doll
Property Owner Phone 701-266-5010
Number (enter WITH
dashes, eg 303-123-
4567)
Property Owner Email motdole al®gmall.com
Address
Attach City of Wheat Electronic Payment Form.odf
Ridge Electronic
Payment Form -'*DO
NOT ATTACH A
PICTURE OF A
CREDIT CARD"
CONTACT INFORMATION
Submitting General Pyramid water Inc
Contractor or Architect
Contractors License 160140
Number (This is a 5 or
6 digit number for the
City of Wheat Ridge)
Contract Phone
72a291 -13e8
Number (enter WITH
dashes, eg 303-123-
4567)
Contact Email Address
chlp.howes@aquaserva4u.com
Retype Contact Email
cNnhowes@9quaserve4u.con
Address
Check the appropriate
Plumbing
boxes if the following
work is involved in the
project.
Plumbing Contractor
Pyramid Water Inc
Name
Plumbing Contractor
160140
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
Installation of water softener and carbon tank
Work - Provide a
detailed description of
work including
mechanical, electrical,
plumbing work
occurring,
adding/removing walls,
etc.
Square footage of
6
scope of work
Location of work
assonant
(backyard, on roof, etc)
Project Value (contract
Alae
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
en��—SonPnArM
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 l 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 Chip Howes
Permit
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