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Road Usage Permit Application Form

Permits will be approved or declined within 5 business days. Work cannot start without an approved permit and a copy of the approved permit must be on site at all times.

Please complete the application form below, preview and then submit (preview and submit buttons can be found at the top and bottom of the form).

A printed version of the application form can also be filled-out at City Hall.

If you have any questions, please contact City Yards at 250-469-8600.

For more information, view the Road Usage Permit application for details about Road Usage & Hording Permit Fees, the Traffic Control Plan (work zone site assessment form), the Traffic Plan Detail form, Temporary Asphalt Restoration Options, Excavation, Trenching & Backfilling, and Standard Drawing Details.

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Note: the prime contractor is to immediately notify the Operations Clerk of any changes, including contact information, permit conditions, location changes, etc...
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Work Safe notice of project:
Notice to proceed:
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Permit date/time requested & scheduled work details
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Pick date
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Pick date
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Provide work schedule detail as required.
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Note: end date is when all permanent surface restoration is complete & the contractor has notified the City. The permit must remain open until all work is complete. Failure to do so might result in legal action. Maintenance of the permit areas is the responsibility of the permit holder at all times, unless otherwise noted.
Excavated site surface material(s): Asphalt
Excavated site surface material(s): Concrete
Excavated site surface material(s): Other
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Traffic Information: Where on Roadway
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Traffic Information: Condition(s)
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Traffic control plan detail are included (if no, a TMP needs to be faxed prior to starting work).
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Locates are required, prior to excavating, under the terms of the Road Usage Permit and WCB/Work Safe BC, Occupational Health and Safety Regulations; failure to do so will invalidate the Road Usage Permit. Application FEES are non refundable. All City Bylaws and regulations MUST be followed at all times. See Schedule "B" of KELOWNA TRAFFIC BYLAW NO 8120. Work CANNOT take place within 2m of a tree on a ROW without first obtaining approval from the Urban Forestry Supervisor (250 469-8503).
By checking this checkbox,
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Pick date
As signing authority for the Prime Contractor, by clicking this box:
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