Fillable City of Norfolk Worksheet for Street Excavation Permit (City of Norfolk Nebraska)

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City of Norfolk Worksheet for Street Excavation Permit (City of Norfolk Nebraska)

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Planning & Development
Building Services
309 N. 5
th
Street
Norfolk, NE 68701
P402-844-2060 F402-844-2069
www.ci.norfolk.ne.us
City of Norfolk
Worksheet for Street Excavation Permit
Date ___________________
PERMIT TO CURB GRIND
NOTE ON CURB GRIND SERVICES: A private contractor* will provide this service.
Contractor ______________________________ Phone Number ______________
Applicant ______________________________ Phone Number _____________
Location __________________________________________________________
Specific Information Concerning Job ____________________________________
__________________________________________________________________
Owner ____________________________________________________________
Bill to ____________________________________________________________
Bill to address ______________________________________________________
__________________________________________________________________
Amount of Payment for Permit Fee $15 .
□ Engineering Contacted/Approved ____________________________________
□ Streets Contacted/Approved _________________________________________
Information taken by _________________________________________________
*Private contractor must be registered with the city as a general contractor with a certificate of
liability insurance listing the city as an additional insured.
Rev 10-2019
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City of Norfolk Worksheet for Street Excavation Permit (City of Norfolk Nebraska)

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Completed 10 November 2021

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