Yes No

Yes No

Yes No

Yes No

Proposed Work Information

50 Winfield Scott Plaza, Room 308
Elizabeth, NJ 07201
(908) 820-4103
elizabethnj.org

Property Address *

The City of
Elizabeth

Applicant Signature *

Please attach required documents below. *

Contractor Email *

Attachments

Contractor Information

Proposed Work Description *

Driveway, Apron, Sidewalk, Curb Permit

Depressed Curb

Home Phone # *

Business Phone #

I certify that all the information mentioned above is true to my knowledge.

Property City

Block *

Apron

City, State, ZIP *

Search work site location by address *

Cell Phone #

Fax #

Select the work to be performed:

Mailing Street *

Owner Information

Name *

City, State, ZIP *

Address *

Business Phone # *

Sidewalk

Owner Name *

Cell Phone #

Lot *

Applicant Email *

Curb Cut only w/zoning approval letter

Certification