Request for Right of Way Concrete Permit
Note: This is NOT an application for a Parking Pad - you will need to fill out a separate application.
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 Concrete Will be Installed
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Property Address or Legal Description Where Concrete Will be Installed
Contractor Information
Who is doing the work:
*
Home Owner
Contractor
Contractor Name
*
First Name
Last Name
Company
*
City License Number
*
Is this new or replacement/repair?
*
Repair/Replacement
New
Is this part of a City of Dickinson SID Project?
*
Yes
No
Which project?
*
Residential or Commercial?
*
Residential
Commercial
Type of Work:
*
Sidewalk
Curb (can only be installed by a City Licensed Contractor)
Gutter (can only be installed by a City Licensed Contractor)
Driveway
Approach
Parking Pad — (not applicable; please fill out a Parking Pad Application)
Other
Fees
Description of Work to be Done:
*
Permit Fees
*
prev
next
( X )
USD
Description
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
Expiration Year
DO NOT BEGIN WORK UNTIL A PERMIT HAS BEEN EMAILED TO YOU
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: