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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reason for Proposed WorkNumber of Days needed to Complete Work Emergency Contact Name Emergency Contact Phone Number
