Contact Name *

First Name

Last Name

Phone

(###)

###

####

Permits *

Do you have approved permits, check all that apply

Sidewalk

Roadway

I do not have approvals

Neighboring Properties

Check all that apply

I intend to use neighboring property space

I have my neighbor and landlord permission

I have approved permitting to use my neighbors space

I do not intend to use my neighbors space

Variables & Obstacles

What obstacles are on the sidewalk and the roadway Check all that apply

Fire hydrants

Bus stop

Traffic sign

Poles

Broken concrete sidewalk and curb

Benches

Subway/Utility grates

Manholes

Trees

Sewer grates

Parking sign

Parking restrictions (please describe)

Meters

Bicycle Lane

Other

Electrical

Do you intend to have power to your outside dining environment

Yes

No

Table Partitions

Yes

No

Street side plastic windows

Yes

No

All weather curtains

Yes

No

Bistro Lights

Yes

No