Right of Way Permit - City of Martinsville, Indiana

72 HOURS NOTICE MUST BE GIVEN TO THE BUILDING INSPECTOR OR DEPARTMENT OF PUBLIC WORKS PRIOR TO START OF WORK
ANY VIOLATION OF THIS PERMIT OR CITY CODE COULD RESULT IN IMMEDIATE REVOCATION AND FINES.
Date Issued
Date Format: MM slash DD slash YYYY
Permit Number
Applicant’s Name
Applicant’s Phone Number
Location of Proposed Work
Street Address Address Line 2 City State ZIP Code
Reason for Proposed Work
Number of Days needed to Complete Work
Emergency Contact Name
Emergency Contact Phone Number