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 and 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 and Duration of Closure*
    Date and Duration of Closure Start Date

    Date and Duration of Closure Start Time

    —

    Date and Duration of Closure End Date

    Date and Duration of Closure End Time
14. Contractor*
16. Address*
18. Phone Number*
19. Cell Phone*
21. Email*
23. Traffic Control Provider*
25. 24-Hour Contact Name*
26. 24-Hour Contact Number*
28. 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.

30. Liability and 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.
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field