2. Date*
   Date

   Date
3. Anticipated Start Date*
   Anticipated Start Date

   Anticipated Start Date
5. Applicant/Contractor*
7. Contractor Address*
9. Address2
11. City*
12. State*
13. Zip*
15. Applicant Name*
16. Applicant Phone Number*
18. Contact Name*
19. Contact Phone Number*
21. List of Sub Contractor(s)*
23. Location of Construction (address)*
25. City*
26. State*
27. Zip*
29. Please select type of work
31. Structures

    1. Crosspan
    2. Fillet
    3. Crub Ramp
    4. Drive Cut
    5. Manhole
    6. *Other
32. Surface Work

    1. Sidewalk
    2. Curb/Gutter
    3. Curbwalk
    4. Sub-grade Prep
    5. Pavement
    6. *Other
33. Sub-surface Work

    1. Water
    2. Sewer
    3. Gas
    4. Electric
    5. Phone
    6. Cable
    7. Inlet
    8. Storm Sewer
    9. Boring
    10. Potholes
    11. Irrigation
    12. Monitoring Well
    13. Traffic Signal
    14. Street and Ped Light
    15. *Other
35. *Describe Other Structure
36. *Describe Other Surface Work
37. *Describe Other Sub-surface Work
39. Description of Construction*
    Please be very specific about type, size, and quantity of cuts.
41. LANE CLOSURE WILL BE REQUIRED

    1. YES
    2. NO
43. UPLOAD A FILE WITH A SKETCH SHOWING WORK AREA, KIND OF WORK, AND TRAFFIC CONTROL
45. Estimate of Total Construction Cost $*
46. Materials Cost (Portion in ROW) $*
50. 1. Applicant/Contractor is required to be licensed & bonded in the City of Wheat Ridge.
52. 2. ALL PERMITS must include traffic control plan for the designated area of construction.
54. 3. Permits will not be processed until the traffic control plan has been received and approved by the City.
56. 4. Contractor is required to notify the City 24 hours (Monday-Friday) prior to commencement of construction.
58. 5. Contractor is required to perform all testing and submit the test results to the City within 48 hours.
60. 6. Contractor must notify businesses and residents that will be impacted by the construction 48 hours prior to beginning work.
62. 7. All construction affecting City Right of Way will require Erosion/Sediment Control.
64. 8. Construction shall not begin until permit fees have been paid and the permit has been issued.
66. 9. The permit and traffic control plan (TCP) shall be available on the job site at all times. Absence of a permit on the job site may be grounds for issuance of "STOP WORK ORDER."
68. For details see Permit Testing & Inspection Requirements and/or Chapter 21; Article II. of City Code of Laws located on City Website.
72. FOR NOTIFICATION OF COMMENCEMENT OF CONSTRUCTION

    CALL: (303) 205-7615 or (303) 205-7626

74. Have the following information available when scheduling inspections
    - Permit Number - Location of Cut - Type of Work - Contact Name - Contact Phone Number
76. All work shall be in accordance with the City of Wheat Ridge Standard Drawings and Specifications, Permit Testing & Inspection Requirements and Encroachment Permit Resolution. The applicant shall assume full responsibility and liability, hold harmless and indemnify the City, and pay for all damages or claims resulting from said construction. The Applicant shall notify the appropriate utility companies for locates, and impacted businesses or residents 48 hours prior to construction.
78. Applicants Name*
79. Digital Signature of Applicant*
80. Title*
82. Issuing Officials Signature
83. Date of Issue/Approval
Leave This Blank:


87. 1. Receive an email copy of this form.
88. Email address

    This field is not part of the form submission.

89. Submit

* indicates a required field