Curb Cut Permit Application

CURB CUT PERMIT APPLICATION

Use this application to request authorization to create, modify, or restore a curb cut (driveway approach) within the public right-of-way. The applicant certifies that the information provided is true and complete and agrees to comply with all applicable municipal codes, standards, and permit conditions. Submission does not constitute approval. Fees, bonds, insurance, and other conditions may be required prior to issuance.

Applicant Information

Property / Site Information

Contractor / Agent

Contractor License No.:   State Issued:

Proposed Work — Scope & Plans

Describe the proposed curb cut, driveway approach, and associated work. Include method of construction, materials, proposed slope, drainage measures, and any retaining or protective features. Attach plan sheets, elevations, and traffic control plans as required.

Schedule & Term

Proposed start date:   Estimated completion date:

Permit validity period (if issued) shall be from through unless otherwise extended in writing by the issuing authority.

Fees & Payment Terms

Permit Fee Amount: $   Deposit / Bond (if required): $

Payment schedule: Applicant shall pay the required permit fee in full prior to permit issuance. If a performance bond or deposit is required, it must be posted and accepted prior to the start of work. Late payments are subject to a late fee equal to per month on the outstanding balance and collection costs. Applicant acknowledges financial responsibility for restoration costs in excess of posted bond or deposit.

Insurance, Indemnity & Certifications

Prior to issuance, contractor/applicant shall provide proof of commercial general liability insurance naming the municipality as additional insured, with limits not less than $1,000,000 per occurrence (or as required by municipal standards). Applicant hereby agrees to defend, indemnify, and hold harmless the municipality, its officers, employees, and agents from and against all claims, liabilities, damages, losses, and expenses arising out of applicant's performance under this permit, except to the extent caused by the municipality's gross negligence or willful misconduct.

Certification: I certify that the insurance information provided is accurate and that I will supply a certificate of insurance meeting permit requirements prior to commencement of work.

Standards, Restoration & Inspections

All work performed under this permit must conform to municipal public works standards, street and curb detail specifications, and the direction of authorized inspectors. Applicant shall maintain traffic control plans and shall restore all disturbed public improvements to prior condition or better. Failure to restore or to comply with inspection directives may result in permit suspension, revocation, and/or municipal completion of work at applicant expense.

Compliance, Revocation & Governing Law

Issuance of a permit does not relieve the applicant from compliance with all applicable laws, regulations, and conditions. The issuing authority reserves the right to suspend or revoke this permit for noncompliance, false statements, or unforeseeable hazards. This permit application and any subsequently issued permit shall be governed by the laws and ordinances of the municipality and any applicable state law.

Acknowledgements & Certifications

By signing below, the applicant certifies under penalty of law that the information in this application is true and that the applicant has authority to perform the proposed work or has obtained the owner’s authorization. Applicant agrees to be responsible for all work performed under this permit and for compliance with permit conditions, inspection requirements, and restoration obligations.

Administrative Use Only

Permit No.:   Date Received:

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