Request for Utility Permit
Who is applying?
*
Owner
Contractor
Other
Applicant Email
*
example@example.com
Applicant Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Property Owner Information
Property Owner Name
*
First Name
Last Name
Property Address Where Utility Will be Installed:
*
Property Address Where Utility Will be Installed
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contractor
Type of Contractor:
*
Self (owner)
City Licensed Contractor
Contractor Name
*
First Name
Last Name
Company
*
City License Number
*
Is this a repair/replacement or new service?
*
Repair/Replace
New
Other
Residential or Commercial?
*
Residential
Commercial
Type of Work:
*
Sewer Line
Water Line
Fire Line
Other
Please describe work to be done:
*
Are you doing this work for The City of Dickinson?
*
Yes
No
Permit Fees
*
prev
next
( X )
USD
Description
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
Expiration Year
Signature
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: