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Application for Public Way Obstruction or Use

2. Application for Public Way Obstruction or Use
   PLEASE NOTE THE FOLLOWING INFORMATION  Application of this permit does not include application for any building, plumbing, electric or heating work. Individual permits shall be applied for, approved and issued by the Building Division before work can begin.  The Developer/Property Owner shall complete and agree to all terms of this “Agreement for Use of Public Way” as a condition of obtaining a public way obstruction or use permit. The signature on this application shall be an acknowledgement of the Developer/Owner’s acceptance of all terms of the agreement.  Before a Street Obstruction or Use permit is issued, a Certificate of Insurance shall be submitted and approved by The Village of Skokie as required by agreement for use of the public way. Closures of public ways shall be according to current MUTCD standards.  Please see page 2 for complete schedule of fees.  For aerial encroachments / UAV use a onetime ROW permit fee of $550 per project area to be assessed.
3. 
5. The undersigned hereby applies to the Village of Skokie,
   (Name of Applicant)
7. To temporarily obstruct/use

   1. Public Sidewalk

   1. Public Alley

   1. Public Street
9. Please indicate the number of feet you will temporarily obstruct/use:
11. Scope/Location:
13. Date of Closure:
14. Phone:
16. Hours of Closure:
17. Email:
19. General Contractor:
21. Address:
23. Phone:
24. Fax:
26. The Applicant agrees that all work accomplished, will conform to pertinent ordinances of The Village of Skokie and inspections will be requested in accordance with the procedures of the Department of Community Development and the Public Works Divisions. The Applicant having read this application understands the intent and declares that all statements herein are true. Falsification of any of the above information will result in a violation leading to fines and penalties as described by law.
28. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
30. Electronic Signature*
31. Date:
33. Printed name of developer/property owner:
35. Address:
37. Phone:
38. Email:
39. Fax:
41. Please find the fee schedule below.
    Fee Schedule
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit Submit and Print

* indicates a required field