R. O. W. Permit application

1
City of Lee's Summit

220 SE Green Street

lee's summit, missouri 64063

(816) 969-1800 FAX 969-1809

2. Please Select A Password: _______________________________

2. Contact Person: _______________________________________

3. Address: ______________________________________________

4. City: _________________________________________________

5. State: ________________________________________________

6. Zip: __________________________________________________

7. Phone: ______________________________________________

8. Fax: __________________________________________________

9. E-mail: _______________________________________________
Billing Information
1. Contact Person: _______________________________________

2. Address: ______________________________________________

3. City: _________________________________________________

4. State: ________________________________________________

5. Zip: __________________________________________________

6. Phone:________________________________________________

2. Nearest Cross Street: _________________________________

3. Subdivision Name: _____________________________________

Work Schedule

1. today’s date: ________/________/________

2. date work will begin: _______/________/________

3. date work will be completed: _______/_______/_______

2. Utility Subcontracting For: ___________________________

3. Bill will be sent to applicant

• 
  A sixty dollar fee per permit unit will be billed to the appropriate party.
  

Width of Excavation (ft): __________ LENGTH of Bore (ft): __________

Number of Sidewalk Cuts: __________ NUMBER of Bike-path Cuts: _______

Number of Street Cuts: ____________ Number of Driveway Cuts: _____