Right of Way User Permit ApplicationApplication Date MM slash DD slash YYYY Contractors LicenseMax. file size: 5 MB.Surety BondMax. file size: 5 MB.Address of Work Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Address of Work Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Work To Be PerformedApplicant's Name First Last PhoneApplicant Business Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Applicant 24-Hour ContactTitle PhoneMobileEmail Proposed Start Date MM slash DD slash YYYY Proposed End Date MM slash DD slash YYYY Sq. Footage of Work(Required)Project Amount(Required)Describe work to be doneTotal Value of All Improvements in Right-of-Way***ATTACH TWO (2) COPIES OF PROPOSED ENGINEERING TO APPLICATION*** Attachment 1Max. file size: 5 MB.Attachment 2Max. file size: 5 MB.For Driveway or Cement slab etc....Please include scope of work / plan drawingMax. file size: 5 MB.Permit Fee Is Paid at the Time Permit Is Picked UpDo Not Begin Work Until the Following Is Complete Permit and plans are approved in writing by all appropriate parties. Contractor must have approved permit, plans and construction notes on site Apply for a construction/building permit (if applicable) Erosion control measures are on site Line locates from all affected utilities are completed. Call 811 for location of utilities. (Texas State Law requires 48-hours notice before excavation.) List of all contractor(s) and/or subcontractor(s) who will perform work has been provided Furnish proof of insurance (required) and a bond of surety (if applicable) All construction is to be in strict accordance with this permit and City of Kirby Ordinance O-2018-831Printed Name First Last Date MM slash DD slash YYYY Applicant SignatureDate MM slash DD slash YYYY Applicant Email(Required) City of Kirby - Public Work Director Signature Δ
