Old Town 1RB-PT130123 T_.K...0.,. S a T Y 8 *.
cOFITII. L
3
CONSTRUCTION DEVELOPMENT PERMIT APPLICATION
Name of Applicant 7 j_SIAR Conisrgarrioiv rNc. Date Submitted %-- 2,- 20/.3
Address of Applicant 3 40/ YwcCA 172. (^io well Mo ,vo, Tx. 7502
Phone Number 912- Zi-5550 Fax Number 972 - Z/9- 7099
Location of Construction (address, if available): 44 4/4 .3 r_ O/o row,v, C6YPCLL
Subdivision 016, AppN. Section# Block# 3 Lot#
OR Survey/Abstract# Acreage
Location description (attach vicinity map): fi'1A,,tJd9 l'Zt-/
1. Type of proposed construction or development: 20C-4 L. 72/AIC/Z l �S T
C Residential C Alteration of a natural waterway drainage course
01 Non-Residential f Other (describe & attach drawing or sketch)
C Placement of Fill (in right-of-way or on private property)
2. Description of Construction Permit requested:
❑ Paving ❑ Median or Landscape ❑ Box Culvert
❑ Sidewalk ❑ Water Main ❑ Rip Rap
❑ Drive Approach ❑ R.C.P. ❑ Fill Area
Excavation ❑ Sanitary Sewer Main ❑ Drainage Channel Excavation
❑ Fire Lane ❑ Flume ❑ Slope Protection/Retaining Wall
❑ Bridge ❑ Inlet ❑ Parking Lot
Provide an attachment containing the name and 24-hr. contact phone number
of supervisor(s) for every contractor working under this general permit.
3.All construction shall be in compliance with, but not limited to, the City of Coppell Subdivision
Ordinance, Standard Construction Details, Streetscape Plan and approved plans. The
contractors shall adhere to the City's Erosion Control& Sedimentation Ordinance.
4.Applicant shall provide a copy of approved plans, specifications and the related cost estimate or
contract for the purpose of permit fee calculation verification.
CONSTRUCTION DEVELOPMENT PERMIT APPLICATION Page 2
5.A Construction Inspection Permit Fee shall be paid prior to beginning work, in accordance with
the City of Coppell Fee Ordinance. See Page 3 for calculation formula.
. ... ...... .... ..........................
Amount Due: $ Date
NOTE: A separate excavation permit is required anytime pave,
right-of-way not approved by the City Engineer. P c' __
>Any work requiring closure of a lane of traffic, street
advance by the Engineering Dept., with notification I
closure: , , i. 4e-------
Police Department @ 972-304-3600 Street
Fire Department @ 972-304-3512 Engin Ai i
>Attach barricade plan /trench safety plan of a lane o
➢It is a requirement of this permit that As-Built Drawi
this project. As-Builts consist of 1 set full size paper
CD with Autocad.dwg files.
NOTE:Street closures are allowed from 9:00 a.m.until 3:30 p.m.ONLY
unless otherwise approved by City Engineer.
>A pre-construction meeting is required prior to beginning work related to this permit.
Contact the inspector assigned to your project to schedule the meeting.
Printing your name indicates your acceptance of the terms and conditions of this form:
(..-- P
Signature of Applicant / Contact Number
/t<_-k- 3‘ 0 Cr-t- (-ki ct 7ta i 1 Z.a
Signature of Inspector Contact Number
FOR CITY USE ONLY
Is the fill area located in an identified flood hazard area? C Yes o
If YES, a Floodplain Development Permit is required before any construction can begin.
Is additional information required? C Yes 'No
Are other federal, state, or local permits required? C Yes C No
y,CyRMIT APPLICATION APPROVED C PERMIT APPLICATION DENIED
♦ _�
City .4. Date -
Applicant shall indemnify and forever hold harmless against the City of Coppell each and every claim, demand
or cause of action that may be made or come against it by reason of or if any way arising out of the closure,
blocking, excavating, cutting, tunneling, or other work by the applicant under permit from the City, if such
permit is granted.