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2. Name of Applicant:*
4. Email Address;*
6. Mailing Address:*
8. Address for Mailbox:
   (if different than mailing address above)
10. Nature of Proposed Mailbox Assembly Installation:*

    1. Residential
    2. Commercial
12. For Commercial Only - Name of Business:
14. Type of Proposed Mailbox Assemby Construction*

    1. Standard (Post & Lightweight Box)
    2. Custom Built (Masonry, Heavy Gauge Metal, Multiple Mail Drops)
16. Description of Proposed Mailbox Assembly*
    Specify Materials to be Used
18. Applicant must provide a copy of the property survey, plat or other legal description. Placement of mailbox should be marked on this document.*
20. Ordinance 2012-05 - Mailbox Specifications & Placement
    Ordinance 2012-05 - Mailbox Specifications & Placement
22. Notifications:*

    By submitting this application for permit, I agree that I have reviewed and acknowledged the City's "Requirements for the Placement of Mailbox Assemblies Within Public Rights-of-Way". I agree to comply with the provisions contained within these requirements and understand that failure to comply with any part of these provisions may result in the City removing, relocating or replacing the mailbox assembly at my own expense.

    1. I Agree
    2. Decline
26. For City Use Only:
28. Permit Number: ______________________
30. Approved Date:___________________________
32. Denied Date:______________________________
34. Mailbox Permit Administrator: ___________________________
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit Submit and Print

* indicates a required field