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Mailbox Assembly Permit

  1. (if different than mailing address above)

  2. Nature of Proposed Mailbox Assembly Installation:*

  3. Type of Proposed Mailbox Assemby Construction*

  4. Specify Materials to be Used

  5. 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.

  6. For City Use Only:

  7. Permit Number: ______________________

  8. Approved Date:___________________________

  9. Denied Date:______________________________

  10. Mailbox Permit Administrator: ___________________________

  11. Leave This Blank:

  12. This field is not part of the form submission.