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2. Applicant must fill in all of Section 1 and submit application together with a sketch of work area and the permit fee. If work is for driveway, applicant must provide a sketch indicating dimensions and materials to be used.
6. Section 1 (To Be Filled in by Applicant)
8. Applicant's Information
10. Name*
11. Company Name
13. Address*
15. City*
16. State*
17. Zip Code*
19. Phone Number*
20. Email Address*
22. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
24. Electronic Signature
25. Date
    Date
27. Location of Proposed Work/Event:
29. Address*
31. City*
32. State*
33. Zip Code*
35. Parcel Number or Closest Intersection:*
37. What kind of road or closure request is this?*

    1. Lane Closure
    2. Road Closure
    3. Sidewalk Closure
38. Provide Additional Information about Closure:*
40. Proposed Scope of Work:
42. Brief Description of Work:*
44. Proposed Start Date and Time*
    Proposed Start Date and Time

    Proposed Start Date and Time
45. Proposed End Date and Time*
    Proposed End Date and Time

    Proposed End Date and Time
49. Right-of-Way Use Permit Fee Schedule:
    • After-the-fact Permitting (Commencing work without permit or violation of permit conditions): Double the Fees
    • Construction Equipment ROW Use/Parking Permit (Metered): $25 per day
    • Construction Equipment ROW Use/Parking Permit (Unmetered): $10 per day
    • Full Road Closure (Time limitations & restrictions determined by Staff): $60
    • Lane/Sidewalk Closure (Time limitations & restrictions determined by Staff): $30
    • Moving Van/Moving Truck/Moving Trailer/Storage Pod (Within City Right-of-Way): (First 48-hour period Free). Thereafter, charged by per day for a maximum limit of 10 days per use/location. (Does not exempt or include parking meter costs): $25 per day
Leave This Blank:


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

    This field is not part of the form submission.

53. Submit

* indicates a required field