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3. Address*
5. P.P. #*
7. Landowner's Name*
8. Applicant's Name*
10. (If land trust, give trust number, trustee and list all beneficiaries on separate sheet)
12. Landowner's Address*
13. Applicant's Address*
15. Landowner's Phone Number*
16. Applicant's Phone Number*
18. (If applicant is different than the landowner, applicant must have written landowner approval)
20. Relationship of Applicant to Owner*
22. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
24. Applicant's Electronic Signature*
26. SECTION BELOW TO BE COMPLETED BY CITY STAFF
28. Coop Dimensions (4 ft. sq. required per chicken):
31. Run Dimension (8 ft. sq. required per chicken):
34. Maximum number of chickens allowed (not to exceed six chickens):
40. THIS PERMIT IS ISSUED SOLELY FOR THE USE INDICATED, AT THE LOCATION SPECIFIED, ON THE DATE ISSUED.

42. Once your application has been approved by the City, you will receive a secure link from noreply-pay24x7@openedgepay.com in which to pay your application fee.

44. Please choose how you prefer to receive the secure link.*

    1. Text
    2. Email
45. Cell Phone*
46. Email*
48. Your permit will be emailed to you once your payment has processed.
50. Chicken Coop License Approved By:
54. Fees: $25 per chicken coop license; $10 for renewal; $25 per transfer
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field