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4. Contact Information
6. First Name*
7. Last Name*
8. Applicant's Mailing Address
10. Telephone Number*
11. E-mail Address*
13. Company Name
14. Company's Buisness Phone
18. Property Information
20. Block*
21. Lot*
23. Physical Address of proposed opening*
24. If in relation to a project, which project
26. Narrative description of the proposed opening (inclusive of the purpose dimensions (length, width, height depth), reconstruction plans):
28. Certification of Compliance*

    1. Agree

    By checking this box, the applicant certifies that statements and information made and provided as part of this application are true to the best of their knowledge. Applicant further certifies that they have read Chapter 195 of the General Ordinances relating to street openings and will fully comply with the provisions thereto, this application, and all other information submitted. Should any of the information submitted be false or untrue or should any of the work performed be not in accordance with Chapter 195, the permit issued hereto shall be null and void.
30. Signature*
31. Date*
33. Attachments*
    Upload a copy of your property survey indicating where the work will constructed.
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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit Submit and Print

* indicates a required field