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City Office: 515-832-9151 | Utility Office: 515-832-9141

Permit ApplicationsEncroachment Permit Application

I. GENERAL INFORMATION
Date
Date Format: MM slash DD slash YYYY
Permit Number (Office Use Only)
Name of Applicant*
First Last
Address of Applicant*
Street Address City State ZIP Code
Phone*
Name of Property Owner
First Last
Type of Permit Requested:
Length of Time Requested for Permit:
1. Provide a copy of Insurance Certificate or Special Endorsement Form with Application releasing the City, its elected boards, officers, agent and employees from liability or the above mentioned as being additionally insured). 2. Either the City or the permit holder may terminate permit by giving the other party thirty (30) days written notice.
Copy of Insurance or Special Endorsement Form*
II. SITE INFORMATION
Describe Location of Requested Encroachment:
Adjacent Streets, Measurement of Sidewalks, Distance from Streets or Alleys:
Describe Requested Encroachment Completely:
What is it? What does it include? (measurements, contents on sign, etc):
Maximum Height of Encroachment:
Maximum Width of Encroachment:
Approximate Square Footage of Encroachment:
Describe any construction that will take place:
III. SITE PLAN
Upload Site Plan
Date*
Date Format: MM slash DD slash YYYY
Name*
First Last
Completing this field serves as your signature and that the information presented is to the best of your knowledge.
Applicant's Email*
Enter Email Confirm Email

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