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2. This form must be submitted online or by fax, to 360-473-5398, by Thursday 10 a.m. prior to the week that the work is to be done. If you have any questions, contact 360-473-5288. Click here to download the Right-of-Way Closures Submission Form (PDF).

4. From*
6. Company*
8. Phone*
9. Fax
10. Permit #
12. Work Scheduled for Week of:*
13. Work Date Range*
    Work Date Range Start Date

    —

    Work Date Range End Date
15. What street is closed / restricted?*

    Include what type (St, Ave, Pl, Ct & Directionals NE, SW, etc.)

17. From which cross street?*

    Include what type (St, Ave, Pl, Ct & Directionals NE, SW, etc.)

19. To which cross street?*

    Include what type (St, Ave, Pl, Ct & Directionals NE, SW, etc.)

21. Days of the Week the Closure / Restriction Will Occur*
    (e.g. Monday - Friday, Tuesday - Thursday)
23. Work Hours*
    Work Hours Start Time

    —

    Work Hours End Time
25. Type of Restriction*

    (e.g. 1 lane closed intermittently, road closed, no public access, alternating traffic, etc.)

27. Additional Restriction Info

    Select all that apply.

    1. Detour In Place
    2. Expect Delays

    1. Flaggers on Site
    2. Intermittent Closure

    1. Local Access Only
    2. No Public Access
29. Type of Work*

    (e.g. asphalt overlay, water main installation, culvert repair, paving, etc.)

31. Other Remarks or Information
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

* indicates a required field