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Encroachment Permit Application 7.1.23 (Roll Off)Please submit to the Engineering Department electronically by emailing the completed application to encroachments@pismobeach.org rev. 7/1/2023 ADDRESS OF PROJECT LOCATION: OWNER: ADDRESS: CITY/STATE/ZIP: CONTACT PERSON: TELEPHONE#: Please check type of telephone: ☐ Cell / ☐ Office / ☐ Home START DATE: ________________END DATE:__________________ DESCRIPTION OF WORK:________________________________________________________________ ENCROACHMENT PERMIT SUBMITTAL CHECKLIST (to be filled out by City Employee) All of the following items must be submitted prior to issuance of encroachment permit: ☐ Application (All information completed) ☐ Permit Fee of $74 (minor; not requiring inspection) ☐ Start and End Date of Project (This may be updated at a later date if necessary) ☐ Signature of Applicant or Contractor on stating that they have read “The Permit” statement under the general provision and understand the permit requirements ENCROACHMENT PERMIT APPLICATION ENGINEERING DIVISION