Application for Utility Permit

Utility permits are required for utility companies who want to work in the City's right-of-way.

Location/address of work*

Type of work*

Water Gas Sewer Electric Telephone

If other, please explain

Purpose*

New Main Repair Abandon New Service Other

If other, please explain

Method of work*

Open Cut Tunneling Boring Combination Other

If other, please explain

Area to be excavated*

Street Curb Sidewalk Grass Strip

Approximate size (in feet) of area to be excavated*

Beginning date of work*

Ending date of work*

Will work involve closing down a street? Complete shut down of street permitted only in extreme circumstances.)*

Yes

No

Describe method of traffic control to be used if closing down a street or single lane.

Additional information/drawings can be mailed to the City of Mission Hills, faxed at (913) 362-0673, or e-mailed to info@missionhillsks.gov

Contractor name*

Contractor address*

Contractor phone number*

Owner name*

Owner address*

Owner phone number*

Name of person completing form*

Permit No._________________

Date Issued:______________________

Expiration Date:__________________

Permit Cost:______________________

Inspection Fees:__________________

Total Cost:_______________________

Approved By:____________________________________

Date Approved:____________________