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2. Name of Applicant
3. Date
   Date
5. Address
7. Office Phone
8. Cell Phone
10. Proposed Construction Address
    Specific location identification to include limits of construction
12. Proposed Start Date
    Proposed Start Date
13. Estimated Completion Date
    Estimated Completion Date
15. Proposed Construction
17. Please provide a print or sketch of the proposed construction identifying the approximate location of a permanent marker.
19. It is understood and agreed by the application and the issuance of a construction permit that all construction, including but not necessarily limited to cutting, patching and inspection shall be accomplished in accordance with City requirements. Work shall not commence until the written approval is issued to applicant, and shall be completed before construction permit expires.
21. Applicant Agreement
23. Permission is hereby granted to proceed with construction as noted. Applicant shall notify the Lynn Haven Utility Department prior to the commencement of construction at 850-265-0087.
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

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