APPLICATION #1:
To Work in the Public Right of Way 

Park City Municipal Corporation
Engineering Division
445 Marsac Avenue, PO Box 1480, Park City, UT 84060
Office: 435-615-5073     www.parkcity.org     engineering_submittals@parkcity.org

• Allow up to 3 business days to process permit.
• All patchwork done between October 15 and April 15 will be considered temporary. Contractor will be responsible to permanently patch the area after April 15.
• $200 application fee. Nonrefundable (To be paid after application approval)
• Incomplete applications will not be accepted.
• All requirements must be fulfilled prior to submitting your application.

1

Project Address/Location:

 *

Project Address/Location:

2

PCMC Building Permit Number (N/A if you do not have one):

 *

PCMC Building Permit Number (N/A if you do not have one):

3

Project Timeline:

 *

Project Timeline:

Start Date:

End Date:

4

Company Information:

 *

Company Information:

Company Name:

Company Address:

City:

State:(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code:

Phone Number:ext.

5

Contractor's Information

 *

Contractor's Information

Contractor's Name:

24 Hour Phone Number:ext.

Email:

License Number:

Expiration Date:

ALL CONCRETE AND ASPHALT WORK REPAIRS MUST BE COMPETED WITHIN 10 WORKING DAYS OF COMPLETION OF UTLITY WORK

6

Type of Work:

Type of Work:

Residential/Commercial

Major Utility (Water/Sewer)

Minor Utility (Cables, TV, Phone, Fiber, Storm Drainage)

Landscaping

Driveway

If Other, list the type of work being done: If other, type text here.

7

Written description of work being done:

 *

Written description of work being done:

8

Will contractor be disturbing concrete or asphalt? If Yes, you will need a partial or full road closure. Link to the Road Closure application: 

Will contractor be disturbing concrete or asphalt? If Yes, you will need a partial or full road closure. Link to the Road Closure application:

Yes

No

9

Type of pavement:

Type of pavement:

Concrete

Asphalt

10

Paving Contractor's Information:

 *

Paving Contractor's Information:

Paving Contractor's Name:

24 Hour Phone Number:ext.

GUARANTEE BOND

GUARANTEE shall be held for a minimum of one year after the final work inspection as a warranty guarantee.  After one year, if the work in the Right-of-Way (R.O.W.) passes the final R.O.W. inspection the GUARANTEE shall be released.  The payer is responsible to notify the City of any change of address from what is here listed.  If the work does not pass the final R.O.W. inspection, the City will notify the payer of non-compliance, and the payer shall be responsible for resolving the non-compliance prior to the City releasing the GUARANTEE. If the payer does not remedy the non-compliance, it is agreed that the City shall have the right to use the GUARANTEE to remedy the non-compliance, and should these funds be insufficient, the payer shall pay the deficiency.  

BOND IS $2,000

 *If PCMC determines amount of work in ROW to exceed $2,000, a separate fee schedule shall be used.*

 

11

Type of bond:

Type of bond:

Cash

Letter of Credit

Escrow

12

Who should receive the refund of performance guarantee bond?:

Who should receive the refund of performance guarantee bond?:

Contractor (same as above)

Other (property owner, etc.)

13

If Other, list the information of who will be refunded:

If Other, list the information of who will be refunded:

Name:

Mailing Address:

City:

State:(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code:

Phone Number:ext.

Email:

14

Proof of liability insurance in the amount of $2,000,000.00:

Insurance attachment Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

OTHER PERMITS:
If other permits are required, it is the responsibility of the applicant to obtain the forms needed to avoid a STOP WORK ORDER.

Example: Partial Road Closure, Encroachment Permit, Parking, Water System Hot Tap

Engineering Division Applications Link

SCHEDULE INSPECTIONS 24 HOURS IN ADVANCE
engineering_submittals@parkcity.org
435-615-5073

15

I certify that all work will be completed in accordance with Park City's Construction Standards and Conditions of Permit Approval. I acknowledge that as a contractor I am responsible for the full cost of any repairs if the Guarantee Bond does not cover the City's cost.

Agree

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

100%

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