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2. Case Number*

   Insert full case number for accurate payment placement.

   Example: RBN23-00001

4. Name*
5. Email Address
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Fax Number
16. 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.
18. Electronic Signature*
20. Permits & Licenses
    Permits & Licenses
21. Fees Due*
    Fees Due from public portal, or from city staff.
22. Quantity
23. Shipping Cost
25. Taxable
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26. Calculate Totals Proceed to Checkout

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