Hard Surface Application

2. 

3. Hard Surface Permit Application

5. Property Address:*

   Street

7. Property Owner Name:*

8. Phone Number:*

10. Owner Address*

    Street, City, State, Zip Code

12. Owner Email:

13. Who is doing the work?*
    -- Select One --Owner/SelfContractor

15. Contractor Name:

16. Contractor must provide City of Storm Lake with Certificate of Insurance in minimum amount of $1,000,000

18. Number of Garage Spaces:*

19. Requested Driveway Width:*

20. Requested Wing Area:

21. Requested Approach Width:

23. Current Driveway Width:*

24. Requested Patio Dimensions:

25. Please attach detailed drawing:

27. 

29. CALL BEFORE YOU DIG IOWAS ONE CALL 1-800-22-8989 AT LEAST 24 HOURS PRIOR TO ANY EXCAVATION ACTIVITIES

31. By my signature below I agree that I will call Iowa One Call at 1-800-292-8989 prior to any digging activities related to this project. I also agree that the information provided above is correct to the best of my knowledge. I understand that street cuts and curb cuts can only be made by the City of Storm Lake and that I may be charged a fee for this service which must be paid prior to any work being done by the City. I also understand that all repairs to the street cuts and curbs must be done in accordance with City specifications by either the City of Storm Lake or a qualified contractor. Should I elect to use grinding as an alternative to a curb cut I agree that all grinding activity must be completed by a city approved contractor. I agree to make myself available for inspections as required by the City and to call for inspections at least 24 hours in advance of when they are needed.

    By my signature below I agree that I will call Iowa One Call at 1-800-292-8989 prior to any digging activities related to this project. I also agree that the information provided above is correct to the best of my knowledge. I understand that street cuts and curb cuts can only be made by the City of Storm Lake and that I may be charged a fee for this service which must be paid prior to any work being done by the City. I also understand that all repairs to the street cuts and curbs must be done in accordance with City specifications by either the City of Storm Lake or a qualified contractor. Should I elect to use grinding as an alternative to a curb cut I agree that all grinding activity must be completed by a city approved contractor. I agree to make myself available for inspections as required by the City and to call for inspections at least 24 hours in advance of when they are needed.

33. Signature:*

34. Date*
    Date

36. * A separate application is required for curb cuts.

40. For City Use Only
    THIS PERMIT AUTHORIZES CONSTRUCTION OF IMPROVEMENTS SPECIFIED. By signing above, the applicant hereby agrees, in consideration of the issuance of this permit, to assume responsibility for and to hold the City harmless in regard to any and all claims of injury or damage arising from the acts or omissions of the applicant or his/her agents while acting under the authority of this permit. The applicant further agrees to comply with the provisions of the Code of the City of Storm Lake, Iowa and 29 CFR Part 1926.650, 651 and 652 as adopted by the Iowa Division of Labor.

    THIS PERMIT AUTHORIZES CONSTRUCTION OF IMPROVEMENTS SPECIFIED. By signing above, the applicant hereby agrees, in consideration of the issuance of this permit, to assume responsibility for and to hold the City harmless in regard to any and all claims of injury or damage arising from the acts or omissions of the applicant or his/her agents while acting under the authority of this permit. The applicant further agrees to comply with the provisions of the Code of the City of Storm Lake, Iowa and 29 CFR Part 1926.650, 651 and 652 as adopted by the Iowa Division of Labor.

42. Approved by:*

43. Date Approved
    Date Approved

47. City of Storm Lake Building Official ~ 620 Erie Street ~ Storm Lake, IA 50588 ~ 712-732-8002

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49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

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