Street Closure Submission Form

2. This form must be submitted online or by fax, to 360-473-5398, by Thursday 10 a.m. <b>prior to the week that the work is to be done</b>. If you have any questions, contact 360-473-5717. <a href="/DocumentCenter/View/1220" target="_blank">Click here</a> to download the Street Closure Submission Form (PDF).

   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 360-473-5717. Click here to download the Street Closure Submission Form (PDF).

4. From*

6. Company*

8. Phone*

9. Fax

11. Work Scheduled for Week of:*

12. Work Date Range*
    Work Date Range Start Date

    —

    Work Date Range End Date

14. What street is closed / restricted?*

    Include what type it is: street, avenue, place, court, and directionals.

16. From which cross street?*

    Include what type it is: street, avenue, place, court, and directionals.

18. To which cross street?*

    Include what type it is: street, avenue, place, court, and directionals.

20. Days of the Week the Closure / Restriction Will Occur*

    (e.g. Monday - Friday, Tuesday - Thursday)

22. Work Hours*
    Work Hours Start Time

    —

    Work Hours End Time

24. Type of Restriction*

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

26. 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
28. Type of Work*

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

30. Other Remarks or Information

Leave This Blank:


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

    This field is not part of the form submission.

34. Submit Submit and Print

* indicates a required field