Property Type Property Type Residential Commercial Industrial

Permit Type Permit Type New Construction Repairs Relocates Disconnections

Project Description

Project Drawing Please attach a project drawing with the link below.Choose FilesNo Files ChosenAccepted file types: pdf. Max. file size: 1 MB

Homeowner Information

Address

Phone

eMail

Contractor Information

Business Name

Business Address

City

State

ZIP

Business eMail

Business Phone

Agreement Agreement Applicant hereby agrees to indemnify, hold harmless, and defend the District and its agents against all actions, claims, demands, liabilities, loss, damage, or expense, including attorneys’ fees, to persons or property arising out of or relating to the issuance of the permit or the work connected therewith, or from the installation, existence, use, maintenance, conditions, repairs, alteration, or removal of equipment or material due in whole or part to any act, omission, or negligence of the person and any other resident, tenant, or guest of the property. Applicant shall not be liable only in the event the bodily injury, death, or damage to property due to the sole negligence of the District.

eSignature

Date