City of Edina Form Center

2. Date*
   Date
4. Site Address*
6. Owner*
8. Description of Work to Be Done*
10. Attach PDF of Detour & Signing Plan*

    Max file size: 1MB. All Detour Maps must be completed by a Certified Traffic Control Provider. No other maps will be accepted.

12. Date & Duration of Closure*
    Date & Duration of Closure Start Date

    Date & Duration of Closure Start Time

    —

    Date & Duration of Closure End Date

    Date & Duration of Closure End Time
14. Contractor*
16. Address*
18. Phone Number*
19. Cell Phone Number*
20. Email Address*
22. Traffic Control Provider*
24. 24-Hour Contact Name*
25. 24-Hour Contact Number*
27. Display Requirements

    An approved copy of the Road Closure Form must be on site for the duration of the operation. All traffic control signage must be removed within 48 hours after work is completed.

29. Liability & Requirements Acknowledgment*

    I agree that I am a legal adult 18 years of age and older and understand this permit does not release me of any liability for damages that may result from the conducting of this block party. I will comply with all requirements listed, and I understand that applications for road/lane closure permits take up to 72 hours to process.

    1. I agree.
31. Public Data Advisory*

    Most or all of the information you submit on this form is considered public record and would be released upon request.

    1. I have read and understand the Public Data Advisory
Leave This Blank:


33. Submit

* indicates a required field