Water Heater Replacement Permit Application

2. This application is exclusively for RESIDENTIAL REPLACEMENT WATER HEATERS - LIKE FOR LIKE ONLY.
   
   YOU MUST ATTACH A VALID CREDIT CARD AUTHORIZATION 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.

4. Is this application for a replacement water heater like for like?*

   1. Yes

   Commercial water heaters are not currently being processed online. You may be served in person at City Hall from 7:30 am to 3:30 pm M-F.

6. PROPERTY INFORMATION

8. Property Address*

10. Property Owner Name*

12. Property Owner Phone Number (enter WITH dashes, eg 303-123-4567)*

14. Property Owner Email Address (Leave blank if not known)

    If homeowner email is not known, leave this field blank

16. 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.

18. CONTRACTOR INFORMATION

20. Contractor Business Name*

22. Contractor's License Number (This is a 5 or 6 digit number for the City of Wheat Ridge)*

24. Contractor Phone Number (enter WITH dashes, eg 303-123-4567)*

26. Contractor Email Address*

    CHECK FOR TYPOS! You will be notified via this email address when your permit is ready for pick-up.

28. Retype Contractor Email Address*

    CHECK FOR TYPOS! You will be notified via this email address when your permit is ready for pick-up.

30. DESCRIPTION OF WORK

32. Number of gallons*

34. Is the water heater GAS or ELECTRIC?*

36. If GAS, enter # of BTUs. If electric, enter n/a*

38. Where is the water heater located (for example, basement, crawlspace, etc)?*

40. Project Value (contract value or cost of ALL materials and labor)*

42. SIGNATURE OF UNDERSTANDING AND AGREEMENT

44. 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
46. I understand that work may not begin on this property until a permit has been issued and posted on the property.*

    1. Yes
48. 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
50. 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

52. 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:


54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit

* indicates a required field