Driveway Approach Permit Form

Homeowner Info
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Contractor Info
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
License #
Email*
example@example.com
NOTE IF APPROVED: CONSTRUCTION, REPLACEMENT OR REPAIRS MUST BEGIN WITHIN 5 DAYS OF PERMIT ISSUANCE. SIDEWALK SHALL BE REPLACED, OR REPAIRED AND REOPENED WITHIN 7 DAYS OF CONCRETE POUR BACK.
Project Outline
Description of work being done:*
- AT LEAST 24 HOURS NOTICE MUST BE GIVEN TO THE ASSIGNED INSPECTOR PRIOR TO WORK STARTING. A COPY OF THE APPROVED PERMIT MUST BE ON THE JOB SITE AT ALL TIMES. FAILURE TO DO SO MAY RESULT IN A FINE.
- A COPY OF CERTIFICATE OF LIABILITY ATTACHED TO PERMIT REQUEST
- PLEASE REFER TO THE CITY'S STANDARDS AND SPECIFICATIONS TO ENSURE ALL CONSTRUCTION IS IN ACCORDANCE WITH CITY CODE: https://www.lehi-ut.gov/government/public-meetings/planning/design-standards/
Applicant Signature*
Date*

MonthDayYear
Date
Should be Empty:

Homeowner Info