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Submit Enchroachment Permit with Public Works
APPLICANT INFORMATION
:
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Job Location
: (*R)
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Property Owner
: (*R)
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Address
: (*R)
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City
: (*R)
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State
** Please Select **
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ZIP
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Phone Number
: (*R)
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Cell Number
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Email
: (*R)
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CONTRACTOR INFORMATION
:
Name
: (*R)
*
*
Address
: (*R)
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City
: (*R)
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State
: (*R)
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ZIP
: (*R)
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Phone
: (*R)
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Cell Number
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Email
: (*R)
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State License
Number
: (*R)
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License Class
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License Expiration Date
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Contractor City
License Number
: (*R)
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USA Ticket Number
*
REFUNDABLE DEPOSIT
:
Refundable Deposit
Amount
*
Depositor
*
Address
*
City
*
State
*
ZIP
*
Phone Number
*
Cell Number
*
Email
*
DESCRIPTION OF WORK
:
Description Of Work
*
*
ADDITIONAL INFORMATION
:
Two Sets Of Construction
Plans Upload
Upload Construction Plans(PDF Only)
Two Sets Of Traffic
Plans Upload
Upload Traffic Plans(PDF Only)
CONTRACTORS PERFORMING WORK WITHIN THE PUBLIC RIGH OF WAY OTHER THAN
THE GENERAL CONTRACTOR SHALL PULL A RIDER PERMIT PRIOR TO START OF WORK.
Permit Hnadler
information Required
Permit Handler Phone
(*R)
*
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Permit Handler Email
(*R)
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UPLOAD REQUIRED
:
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GENERAL LIABILITY INSURANCE WITH THE CITY OF DOWNEY AS
ADDITIONALLY INSURED AND CERTIFICATE HOLDER WITH APPLICABLE ENDORESEMENTS
*
General Liability Insurance
State Of California
Contractors License Pocket Card
SIGNATURE
:
*
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I UNDERSTAND AND AGREE TO THE CONDITIONS AND REQUIREMENTS OF THIS APPLICATION FOR PERMIT.
Signature Name
: (*R)
*
Phone Number
: (*R)
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Cell Number
*
Parkway Width
*
Sub Reference
*
Submit
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