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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. 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! Your permit will be emailed back to this address.
28. Retype Contractor Email Address*
    CHECK FOR TYPOS! Your permit will be emailed back to this address.
30. DESCRIPTION OF WORK
32. Is this a sewer line or water line repair?*

    1. Sewer Line
    2. Water Line
34. Length of repair *
36. Location of repair (backyard, frontyard, etc)*
38. Provide additional details including installation of clean-outs.*
    If no additional details, enter n/a.
40. Project Value (contract value or cost of ALL materials and labor)*
42. PAYMENT INFORMATION
44. Payment Options*

    Payment for this permit may be submitted online, over the phone, in person, or via mail. Please indicate how you intend to submit payment:

    1. Online
    2. Over the Phone
    3. In Person
    4. Mailed Check
46. Online Payment Contact*

    Please provide the NAME and EMAIL of the person who will be paying for this permit. City staff will contact this person with payment directions when we are ready to receive payment.

    CHECK FOR TYPOS! Errors may delay processing.

48. Phone Payment Contact*

    Please provide the NAME and PHONE NUMBER of the person who will be paying for this permit. City staff will contact this person with payment directions when we are ready to receive payment.

    CHECK FOR TYPOS! Errors may delay processing.

50. SIGNATURE OF UNDERSTANDING AND AGREEMENT
52. 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
54. I understand that work may not begin on this property until a permit has been issued and posted on the property.*

    1. Yes
56. 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
58. 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
60. 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:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field