Permit Application Form

Permit Request Form

Please Fill Out the Form Below to Submit Your Permit Request!
Name and Company*

First and Last NameCompany
E-mail*
example@example.com
Phone Number*
Proposed Start Date*

MonthDayYear
Date
Proposed End Date*

MonthDayYear
Date
Scope of Work (Include dimensions in feet)*
Provide all streets and blocks that the work will take place*
List any and all subcontractors that may be working under your permit (Put "None" if no other contractors will be performing work under your permit)*
Provide your Building Permit or Site Plan number (if applicable)
Provide your Utility Coordination Case (UCC) Number (if applicable)
Provide your General Permit Number (if applicable)
Letter of Authorization (You must list LACA Traffic Solutions on your Authorized Agent Form (AAF) OR provide a letter in writing authorizing LACA Traffic Solutions to pull a permit on your behalf)*

Cancelof
Traffic Control Plan (if available)

Cancelof
Utility Plan

You can share certificates, diplomas etc.
Cancelof
Normal Service or Expedited Service? Normal service means that we will submit the permit application on your behalf within five (5) business days of receiving this form. Expedited service means that we will submit your permit application within 24 business hours of receiving this request. *Note: This does not guarantee your permit will be approved in these timeframes**

Normal ServiceExpedited Service
If you would like the invoice for payment to go to someone else to pay (i.e. your finance department), please provide the name and email to send the invoice to. Otherwise, the invoice will be sent to the email provided above.

First and Last NameEmail
You agree that all the information provided is true and correct to the best of your knowledge at time of submittal. (Please note: Incorrect information may result in delays in obtaining a permit)*
Once this form is submitted, we will review this and reach out to you if further information is needed.
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Permit Request Form