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2. Applicant Information
   Work in the City Rights-of-Way (ROW) require a current license, insurance and bond with the City of Cañon City. ROW closure do not require a bond.
4. Company Name
6. Address
8. City
9. State
10. Zip Code
12. Phone Number
13. Email Address
15. Authorized Representative Name
17. Phone Number
18. Email
22. ROW/Site Information

    Mark all that apply:

    1. Encroachment Only
    2. Excavation
    3. Pavement Cut
    4. Road or Lane Closure
24. Permit and cut fees will be billed out following the completion of the project. Inquiries regarding permit fees can be estimated by the Public Works Inspector.
28. Purpose of Work

    1. Concrete/ Paving
    2. New Utility Service
    3. Overhead
    4. Utility Installation
    5. Utility Repair
29. Purpose Information
31. Location Address
33. City
34. State
35. Zip Code
37. Location Description
41. Contractor is to notify Fire, Police, Ambulance via dispatch by calling 719-276-5600.
45. Sketch of Proposed Excavation
    Attach sketch of proposed work area to include location, cross streets, and other relative information as required.
49. Estimated Date of Commencement
    Estimated Date of Commencement
50. Estimated Date of Completion
    Estimated Date of Completion

    Estimated Date of Completion
54. In accepting this permit the undersigned, representing the Permittee, verifies that he has read and understands all applicable resolutions, ordinances, rules and regulations; that he has authority to sign for and bind the Permittee, that the Permittee is a licensed contractor with the City and the appropriate bond has been submitted: and that by virtue of his signature the Permittee is bound by all conditions applicable.
56. Electronic Signature Agreement
58. Representative Name
59. Date
    Date
Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field