Application for Revocable License Agreement

2. Awning, canopy, marquee signs or projecting signs which extend over the City’s rights-of-way require a revocable license from City Council prior to receiving a building permit (Section 39-347 of the Ordinance Code). Also, a revocable license agreement is required from the City Council to install groundwater monitoring wells.

   The following four (4) documents must be provided:

   1. Application
   2. Valid Insurance Certificate
   3. Proposed Activity Plan or Sketch
   4. $350 check
      1. Please bring payment to the City Manager's Office: 
      2. Holland City Hall, 2^ndFloor
         270 South River Avenue
         Holland, MI 49423
      3. Application will not be processed without payment.
4. Project Address*
6. Business Name*
7. Business Phone #*
9. Business Address*
10. Zip Code*
12. Business Owner Name*
13. Email Address*
15. Business Owner Address (if different)*
16. Zip Code*
18. Building Owner Name*
19. Building Owner Phone #*
21. Email Address*
23. Building Address*
24. Zip Code*
26. Partnership or Other Address*
27. Zip Code*
29. Name of who is responsible to sign the agreement*
30. Email Address*
32. General Description of Proposed Work (height, length, width, materials, distance between walking surface and bottom of encroachment, etc.); include plan showing elevation and end section: *
34. Lettering, logo, or artwork on encroachment? If yes, explain:*
36. General Conditions Applicable to this Permit:

    Permit Application Fee $350 payable to City of Holland (Cost of the building permit not included in this amount).   

    Legal description of property. 

    Insurance Requirements:  All insurance documents must show City of Holland as the Certificate Holder: City of Holland, 270 S. River Avenue, Holland, MI 49423 (no person’s name or department). Also, where there are notes at the bottom, the following must be included: The City of Holland, its officers, agents and employees are named as Additional Insureds for general and automobile liability insurance. Waiver of Subrogation is Applicable. If the certificate says Per Written Contract, it will be rejected! The City of Holland does not have written contracts with individual contractors.  We simply issue right-of-way permits.

38. Insurance Certificate File Upload*

40. Although a building permit is also required, it cannot be issued until the Revocable License Agreement is approved by City Council and prepared by the City Attorney.  (Building permits issued by the Department of Community and Neighborhood Services).   All work must comply with applicable regulations and ordinances. 

    Specific Conditions Applicable to this Permit will be attached and made a part of this permit.

42. Parties &/or Partners authorized to sign agreements
44. Signature*
45. Title*
46. Date*
    Date
48. Signature
49. Title
50. Date
    Date
52. Signature
53. Title
54. Date
    Date
56. Proposed Activity Plan or Sketch File Upload*
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

* indicates a required field