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2. Date*
   Date
3. Anticipated Start Date*
   Anticipated Start Date
5. Applicant/Contractor*

   MUST have a valid Municipal Contractors License ** Permit will not be issued if not licensed **

7. Contractor Address*
9. Address
11. City*
12. State*
13. Zip*
15. Contact Name*
16. Contact Phone Number*
18. Contact Email Address*
20. List of Sub Contractor(s)*

    Sub Contractors MUST have a valid Municipal Contractors License (N/A if no Sub Contractors) *Permit will not be issued if Sub Contractor is not licensed*

22. Location of Construction (address)*
24. City*
25. State*
26. Zip*
28. Detailed Description of Construction*

    Please be very specific about type, size, and quantity of cuts.

32. Estimate of Total Construction Costs*
33. Materials Cost (Portion on ROW)*
37. Please select type of work
39. Structures $80 Each*

    1. Crosspan
    2. Fillet
    3. Crub Ramp
    4. Drive Cut
    5. Manhole
    6. *Other (Describe Below)
    7. None
40. Quantities *

    Enter how many for each (if none use n/a)

42. *Describe Other Structure
44. Surface Work $.55 per SF ($80 Minimum)*

    1. Sidewalk
    2. Curb/Gutter
    3. Curbwalk
    4. Sub-grade Prep
    5. Pavement
    6. *Other (Describe Below)
    7. None
45. Quantities*

    Enter how many sf (if none use n/a)

47. *Describe Other Surface Work
49. Sub-surface Work $.55 per SF ($100 Minimum)*

    1. Water
    2. Sewer
    3. Gas
    4. Electric
    5. Phone
    6. Cable
    7. Inlet
    8. Storm Sewer
    9. Boring $.55 per LF ($100 Min)
    10. Potholes $35 Each
    11. Irrigation
    12. Monitoring Well $150 Each
    13. Traffic Signal $500 Each
    14. Street and Ped Light $125 Each
    15. *Other (Describe Below)
    16. None
50. Quantities*

    Enter how many sf, lf, or each (if none use n/a)

52. *Describe Other Sub-surface Work
56. LANE CLOSURE WILL BE REQUIRED*

    1. YES
    2. NO
60. UPLOAD A FILE WITH A SKETCH SHOWING WORK AREA, KIND OF WORK, AND TRAFFIC CONTROL*
62. File Upload
64. File Upload
68. 1. Applicant/Contractor and all Sub-Contractors are required to be licensed & bonded in the City of Wheat Ridge.
70. 2. ALL PERMITS must include traffic control plan for the designated area of construction.
72. 3. Permits will not be processed until the traffic control plan has been received and approved by the City.
74. 4. Contractor is required to notify the City 24 hours (Monday-Friday) prior to commencement of construction.
76. 5. Contractor is required to perform all testing and submit the test results to the City within 48 hours.
78. 6. Contractor must notify businesses and residents that will be impacted by the construction 48 hours prior to beginning work.
80. 7. All construction affecting City Right of Way will require Erosion/Sediment Control.
82. 8. Construction shall not begin until permit fees have been paid and the permit has been issued.
84. 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."
86. For details see Permit Testing & Inspection Requirements and/or Chapter 21; Article II. of City Code of Laws located on City Website.
90. FOR NOTIFICATION OF COMMENCEMENT OF CONSTRUCTION AND INSPECTION REQUEST PLEASE CALL (303) 205-7615

    Please have the following information available when scheduling inspections

    - Permit Number - Location of Cut - Type of Work - Contact Name - Contact Phone Number

    
    

92. 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.

94. Applicants Name*
95. Applicant Phone Number*
96. Applicant Email Address*
98. Issuing Officials Signature
99. Date of Issue/Approval
Leave This Blank:


103. 1. Receive an email copy of this form.
104. Email address

     This field is not part of the form submission.

105. Submit

* indicates a required field