2. Original Right of Way Permit Number*
4. Applicant First and Last Name*
6. Applicant Phone Number*
8. Applicant Email*
10. Reason For Permit Extension*
12. New Date for Completion of Project (Can Not Exceed 60 Days)*
14. Changes or Additions to Original Project Causing Additional Time Need for Completion*
16. Fees

    A fee of $100 for each extension period is required. An invoice will be sent to the email address provided.

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18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field