Park West CC(7)-PT020513o
T H · · G I 1' Y · 0 If
COPPELL
CONSTRUCTION DEVELOPMENT PERMIT APPLICATION
N~me of Applicant: ~. t~,]~ (?Ofi~rio~c_~r_~'x~/
Location of Construction (address):
Subdi~ion Section #
OR
Block # Lot #
Acreage
Location description (attach ~icinity map~.~ OO rn ~r ~ ~
SurFo/Abstract #
Type of proposed construction or development:
( ) Residential ( ) Alteration of a natural waterway drainage course
()
Non-residential
(' PTce. ment of Flll (in riTht'of'wa~ °r °n pri'ate pr°perly)
Description of Construction Permit requested: ,e. ~:- f~-ff~C,~e~
(~) Paving ( ) Mea!~m or Landscaping ( ) Box CulveFt
(.) Sidewalk ( )Water Main ( ) Rip Rap
( ) Drive Appreach ( ) R,C,P, ( ) Fill Area
( ) Excavation
( ) Fire Lane
( ) Bridge
( ) Sanitary SeweF Main
( ) Flume
( ) Inlet
( ) Drainage Channel Excavation
( ) Slope Protection/Retaining Wall
( ) Parking Lot
· :. Please provide the name, address and 24 ho~r phone .;3umber for suL)ervisor of every
contractor working under thk genera] permit.
All construction shall be In compliance with, but not limited to, the City of Coppell
Subdivision Ordinance, Standard Construction I~all.~, Strotqscap~ plpn and approved
plans. The contractoFs shall adhere to the City's EFoslon and Sedimentation Ordinance,
o
Applicant shall provide a copy of approved pla~, specifications and related cost estimate
or contract of the proposed construction for the purpose of permit fee calculations.
CONSTRUCTION DEVELOPMENT PERMIT APPLICATION Page 2
A Construction Permit Fee in accordance with the City of Coppeli Fee Orain=nce shall be
paid prior to be~nntng work. ~.2, ~c:OoO
Amount Due: "~/0~°° Date Paid: S/I ~/O ~--
NOTE: A separate excavation permit is required anytime pavement is cut or wltm ther~
is work in the rigltt-of-way not approved by the ~ Engineer.
Any work requiring dosing of a lane of traffic, street, or alley must be approved by the
Engineering Dept. with notification to the following prior to closing:
Police Department 0 972-304-3600
Fire Department 0 972-304-3500
Street Department ~ 972-304-3546
Engineering Department ~ 972-304-3679
Attach barricade plan / trench safety plan of a lane or street closure. (Required)
Note: ~treet closures are allowed from 9:00 a.m. until 3:00 p.m. OIVZY #nlese otherwise
approved by City Engineer.
A pre-construction meeting is required prior to beginning work related to thi.q pea-mit. Contact
the in~sp;ector to schedule meeting.
-- Sig-nat~e o'~'Ap'plica~t Dam
/p^vls
City Inspector
/ Contact Number(s)
FOR CITY USE ONLY
Is the fm area located in an identified flood hazard area? ( ) YES ( ) NO
If YES, then a Floodplain Development Permit is required before any ¢onstntction can begin.
Is additional !~formation required? ( ) YES ( ) NO
Are other federal, state, or local permits requires? ( ) YF~ ( ) NO
( ) PERMIT APPLICATION DISAPPROVED
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 tbe e. lomre,
blocking, excavating, ~_m_'.ng, tunneling, or other work by the applicant under permit from. the C'YO, if such
permit is granted.