CF-Cozby Library-PT051012
THE.CITY'OF
1.
CONSTRl1CTION DEVELOPMENT PERlVlIT APPLICATION
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Name of Applicant: C 1"1 0 p ~ f'fC (. L-- '-Fo-u ( Date Submitted: I {) .- If -tJ 1
Address of Applicant: -BJ ~ .s" [prr( LL P-.6.
Phone Number: (J,i'1?) 4(02 - 5/5 L FAX NUMBER: [q72J c/ /; Z ~'I q 0;
2.
Location of Construction (address, if available): /77 /\f, H eA (t7- l? d .
Subdivision
Section #
Lot #
Block #
OR
Survey/Abstract #
Acreage
3.
Location description (attach vicinity map): \iJ<'S f" Sid e of' L,J,r"':J 4~
Type of proposed construction or development:
4.
( ) Residential ( ) Alteration of a natural waterway drainage course
( ) Non-residential f Other (describe & attach drawing or sketch)
( ) Placement of Fill (in right-oj-way or on private property)
tl.t!C6lJ.StICal
Description of Construction Permit requested: SC/feE-' V) I~ ~ ~ \
( ) Paving ( ) Median or Landscaping () 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 ProtectionlRetaining Wall
( ) Bridge ( ) Inlet ( ) Parking Lot
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.:. Please provide the name, address and 24 hour phone number for supervisor of every
contractor working under this general permit.
5. 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.
6. Applicant shall provide a copy of approved plans, specifications and related cost estimate
or contract of the proposed construction for the purpose of permit fee calculations.
CONSTRUCTIO~ DEVELOPMENT PER\nT APPLICATION
Page 2
7. A Construction Permit Fee in accordance with the City of Coppell Fee Ordinance shall be
paid prior to beginning work.
Amount Due:
"'/A
Date Paid:
N/A
NOTE:
A separate excavation permit is required anytime pavement is cut or when there
is work in the right-of-way not approved by the City Engineer.
>- Any work requiring closing 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 @ 972-304-3600
Fire Department @ 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: Street closures are allowed from 9:00 a.m. until 3:00 p.m. ONLY unless otherwise
approved by City Engineer.
>- A pre-construction meeting is required prior to beginning work related to this permit. Contact
.... t~pector to schedule meeting.
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./ Signature of Applicant Printed Name Contact Number
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City Inspector
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Contact Number(s)
FOR CITY USE ONLY
Is the fill area located in an identified flood hazard area? ( ) YES P{ NO
If YES, then a Floodplain Development Permit is required before any construction can begin.
Is additional information required?
( ) YES
( ) YES
~NO
() NO
Are other federal, state, or local permits requires?
~PERMIT APPLICATION APPROVED
( ) PERMIT APPLICATION DENIED
~~ ~
City Approval
/0/ I t / (/" ~
· Date
Applicant shall indemnify and forever hold hamzless against the City of Coppell each alld every claim, demand
or cause of action that may be made or come against it by reaSOll of or if allY way arising out oJ the closure,
blocking, excavating, cutting, tunneling, or other work by the applicant under permit from the City, if such
permit is granted.
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