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2. City of Wheat Ridge

   Community Development Department7500 W. 29th Avenue, Wheat Ridge, CO 80033Phone: (303) 235-2846 Email: zoning@ci.wheatridge.co.us 

4. NOTICE TO MINERAL ESTATE OWNERS

   APPLICANTS: You must submit this completed form to the Community Development Department no later than ten (10) days before the public hearing on your application. Failure to complete and submit this Certification of Notice shall constitute sufficient grounds to reschedule your public hearing.

6. First Name*
7. Last Name*
9. Position/Job Title*
10. Entity applying for permit/approval (Applicant)*
12. Application Type*
    -- Select One --Final Subdivision Plat Rezoning (including Planned Developments)Special Use Permit (if City Council approval is required)
14. Public Hearing Date*
    Public Hearing Date
16. Are mineral interest owners present*

    1. Yes, there are mineral owners on a portion of the subject property.
    2. There are NO mineral estate owners of any portion of the subject property.
18. Certification

    By signing below, I do hereby certify that notice of the above-referenced application, set for public hearing on the above-referenced hearing date, has been sent to all mineral estate owners at least thirty (30) days before the public hearing, as required by Colorado Revised Statutes Section 24-65.5-103(1), or in the alternative that the records of the Jefferson County Clerk and Recorder do not identify any mineral estate owners of any portion of the property subject to the above-referenced application.

    I hereby further certify that I am authorized by the Applicant to make representations contained herein and act as the Applicant’s agent for purposes of this Certificate of Notice and bind the Applicant to these representations by my signature below.

20. Signature (print and sign)

    
    

    __________________________________________________

21. Date

    
    

    __________________________________

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22. Print Only

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