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1290 S. Public Road Lafayette, CO 80026 [PHONE REDACTED] x3328 [PHONE REDACTED] fax www.cityoflafayette.com Updated 02/17/2012 Street Closure Permit Contact Name Contact Telephone Number Date of Closure Day of Week Closure Time Type of Event Street(s) To Be Closed (Please include drawing) Location for Drop-Off & Pick-Up of Barricades: Signatures of residents affected by Street Closure (must be signed prior to issuance of permit – attach more sheets if necessary) Name Address NOTE: Permit form must be received by Public Works at least 72 hours before event. Permit fee of $25 received by Finance: Approved by Public Works: Police Department Fire Marshal Streets Superintendent