2. YOU MUST ATTACH AN ELECTRONIC PAYMENT FORM IN ORDER FOR THE PERMIT TO BE PROCESSED
4. THIS APPLICATION DOES NOT CONSTITUTE A PERMIT. DO NOT BEGIN WORK UNTIL PERMIT HAS BEEN ISSUED.
6. LOCATION ELIGIBILITY: I attest that the proposed location has been approved by the Planning Division and the address I will provide on this form is the address provided to me by the Planning Division.*

   1. Yes

   If no, DO NOT submit this application. Contact the Planning Division at 303-235-2846 or zoning@ci.wheatridge.co.us to verify the location of the proposed facility is eligible. If eligible, you will receive an email stating as such and will receive an address assignment, and can then apply for the permit
8. RIGHT-OF-WAY PERMIT: I attest that the proposed location is in City of Wheat Ridge right-of-way and understand I must also obtain a separate Right-of-Way Permit from the Engineering Division to be authorized to construct the small cell facility in City right-of-way.*

   1. Yes
10. LOCATION INFORMATION
12. Location Address*
14. Location Coordinates*
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. CONTACT INFORMATION
20. Submitting General Contractor or Electrician*
22. Contractor's License Number (This is a 5 or 6 digit number for the City of Wheat Ridge)*
    If being submitted by an Architect or Owner, enter "00000" Note that permit cannot be issued until a contractor licensed in the City of Wheat Ridge is identified.
24. Contact Phone Number (enter with dashes, eg: 303-123-4567)*
    Provide contact for questions or comments
26. Contact Email Address for questions or comments*
    CHECK FOR TYPOS! Your permit will be emailed back to this address.
28. Retype Contact Email Address*
    CHECK FOR TYPOS! Your permit will be emaild back to this address.
30. DESCRIPTION OF WORK*
32. Project Value (contract value or cost of ALL materials and labor)*
34. Upload completed Small Cell Location & Justification form.*
36. Upload Drawings 11" x 17" or larger including elevations, site plan, and electril plans*
38. Upload owner permission of colleocating on or modifying an existing pole.*
40. SIGNATURE OF UNDERSTANDING AND AGREEMENT*

    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
42. I understand that work may not begin at this location until this permit and a Right-of-Way Permit has been issued*

    1. Yes
44. I understand that work may not begin until a Small Cell Master License Agreement has been executed with the Department of Public Works (One agreement is required per telecom)*

    1. Yes
46. I attest that everything state in this application is true and correct and that falsifying information in this applicaton is an act of fraud and may be punishable by fine, imprisonment, or both.*

    1. YES
48. Person Applying for Permit*
    Must be a person's name, not the name of the company or the application will rejected. Person must be listed as a person able to pull permits for the licensed contractor.
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field