2. 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.
4. Is this application for sewer line or water line repair - in yard only?*

   1. Yes
6. PROPERTY INFORMATION
8. Is this Residential or Commercial?*

   1. Commercial
   2. Residential
10. Property Address*
12. Property Owner Name*
14. Property Owner Phone Number (enter WITH dashes, eg 303-123-4567)*
16. Property Owner Email Address
18. Attach City of Wheat Ridge Electronic Payment Form - **DO NOT ATTACH A PICTURE OF A CREDIT CARD***
    Your application cannot be processed if the City of Wheat Ridge electronic payment form is not attached. There is specific information on the form that is needed to run the payment.
    The form is located here: Electronic Payment Form Be sure to save to your computer before attaching to this application.
20. CONTRACTOR INFORMATION
22. Contractor Business Name*
24. Contractor's License Number (This is a 5 or 6 digit number for the City of Wheat Ridge)*
26. Contractor Phone Number (enter WITH dashes, eg 303-123-4567)*
28. Contractor Email Address*
    CHECK FOR TYPOS! Your permit will be emailed back to this address.
30. Retype Contractor Email Address*
    CHECK FOR TYPOS! Your permit will be emailed back to this address.
32. DESCRIPTION OF WORK
34. Is this a sewer line or water line repair?*

    1. Sewer Line
    2. Water Line
36. Length of repair *
38. Location of repair (backyard, frontyard, etc)*
40. Provide additional details including installation of clean-outs.*
    If no additional details, enter n/a.
42. Project Value (contract value or cost of ALL materials and labor)*
44. SIGNATURE OF UNDERSTANDING AND AGREEMENT
46. I assume full responsibility for compliance with applicable City of Wheat Ridge codes and ordinances for work under any permit
    issued based on this application.*

    1. Yes
48. I understand that work may not begin on this property until a permit has been issued and posted on the property.*

    1. Yes
50. I certify that I have been authorized by the legal owner of the property to submit this application and to perform the work described above.*

    1. Yes
52. I attest that everything 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.*

    1. Yes
54. Person Applying for Permit *
    Must be a person's name, not the name of the company or the application will be rejected. Must be listed as a person able to pull permits for the licensed contractor.
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field