Right of Way Permit 72 HOURS NOTICE MUST BE GIVEN TO THE BUILDING INSPECTOR OR DEPARTMENT OF PUBLIC WORKS PRIOR TO START OF WORKANY VIOLATION OF THIS PERMIT OR CITY CODE COULD RESULT IN IMMEDIATE REVOCATION AND FINES.Date Issued MM slash DD slash YYYY Permit Number Applicant’s Name Applicant’s Phone NumberLocation of Proposed Work Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Reason for Proposed WorkNumber of Days needed to Complete Work Emergency Contact Name Emergency Contact Phone Number
