CITY OF COUNCIL BLUFFS, IOWA
ANNUAL OVERSIZE PERMIT
(LENGTH - WIDTH - HEIGHT - WEIGHT)
ANNUAL PERMIT NUMBER:_____________________________ VALID DATES:_______________ TO_______________
STATE PERMIT NUMBER:
_______________________________________ PERMIT EXPIRES:_____________________________________
Permit accuracy, information, and requirements provided are the responsibility of the applicant and/or driver. Permit issuing authorities will not be
responsible for any damages that are a result of the move. This document must be accompanied by an Iowa Department of Transportation oversize
permit if entering or exiting the City on a Federal or State roadway or an adjoining county permit if required by that county.
Issued to:__________________________________________________________________________________________
Address:___________________________________________________________________________________________
__________________________________________________________________________________________________
Phone:_____________________ Fax:_____________________ Email:________________________________________
Applicant (Print):_____________________________ Signature:________________________________ Date: ________
City Official (Print):___________________________ Signature:________________________________ Date: ________
If paying by credit card, please sign on the line below.
CC Authorization Signature:
Please fax credit card authorization form to the City Treasurer at 712-328-4689. The above CC Authorization
signature must match the signature on the credit card authorization form in order to process and complete
the payment.
Additional Permit Information
• NO load information is required at time of permit application.
• Must provide load and route on the additional information sheet 24 hours prior to hauling loads that permit
is required. Additional information sheets shall be attached to the annual permit.
• Load and route information shall be considered accepted unless carrier receives a denial notification.
• General guidelines shall be followed to meet the requirements of the permit.
POWER UNIT LICENSE # & STATE
POWER UNIT REGISTERED WEIGHT
Engineering Division
Right Of Way Office
Office 712-328-4635
Receipt Number: ______________________
Permit Fee: $250.00
Budget Code: C02001-419010
