Public Works Permit Request
Location: 120 Ramsdell St, Fircrest, WA 98466 ∙ Contact: (253) 564-8900 ∙ Email: PublicWorks@cityoffircrest.net
Applicant
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Contractor Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contractor
UBI #
Phone Number
Please enter a valid phone number.
Email
example@example.com
Business License
Contractor License
Job # (if applicable)
Project Location Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Location of Work:
DESCRIPTION OF WORK:
*
Will You be Cutting into the Street and/or Right-of-Way?
*
Please Select
YES
NO
If Yes - Approx. Length of Excavation
PURPOSE
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New
Maintenance
Repair
Replace
TYPE OF SERVICE
*
Water
Sewer
Stormwater
Driveway/Driveway Approach
Sidewalk/Curb/Gutter
Gas
Electricity
Telephone
Other
Please upload your document
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DETAILED SITE PLAN- Showing existing sidewalk(s), curb(s), gutter(s), Planter Strip(s), Property Lines and Right of Way lines & PHOTOGRAPHS/DRAWINGS - showing location(s) of proposed work in all directions.
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of
Did you include a Detailed Site Plan?
*
Please Select
YES
NO
Did you include a PHOTOGRAPH(s)/DRAWING(s)?
*
Please Select
YES
NO
Did you include a Traffic Plan (if required)
*
Yes
No
N/A
Signature
*
Date
-
Month
-
Day
Year
Date
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