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ROAD CLOSURE REQUEST
Community& Economic Development
City of Arlington • 18204 591h Avenue NE • Arlington,WA 98223 • Phone(360)403-3551
Name/Company: s— orihodoy rhvrch
Street: Z O -E
Date: 2-- 2-
Time: --
Purpose: CGl VO7 — I &G1 ,SFe r C2 r'•
Complete Closure 0 Partial Closure O Diversion Closure
(i.e. no access) (i.e.one lane of traffic) (i.e. to turn lane)
Describe what section of the road will be closed using cross streets or a street address with the total
linear footage of closure. l
i e w,be r r r Qe- f ro w e 3o
Please briefly explain your traffic control plan and/or detour route, including safety precautions that
will be taken in the evenings for multiple day closures. Attach a traffic control plan in necessary.
C o .�
30 ised 10/2013
CONSTRUCTION PERMIT APPLICATION
Community and Economic Development
City of Arlington • 18204 59ih Avenue NE Arlington,WA 98223 • Phone(360)403-3551
CIVIL(TYPE I) GRADING/PAVING/DRAINAGE(TYPE II) RIGHT OF WAY(TYPE III)-
TYPE I&II ONLY NEW DEVELOPMENT REDEVELOPMENT
Project Name:
Project Address/Location: 3 U iA d'j�2 /� Tax Parcel I.D.#:
Description of Project: rn )^ Vo I
Project Size in Acres: DOE General Construction Stormwater Permit#:
OWNER
Name: PI V 1 111
Address:0 Z Z ,6 I Z" I J t I. N
City: 1 rii State: Zip: �p ZZ�Phone: VIZ 3 S� 7
Email: O V1
APPLICANT
Name: �Xdeor
Address: Z S 'b VIP e�"'
Ci : State: Zip: 9'7Z3 Phone: Z s ' q-3— Z-7 S
Email:
ENGINEER `J
Name:
Address:
City: State: Zip: Phone:
Email: License#: Expiration:
CONTRACTOR
Name:
Address:
City: State: Zip: Phone:
Email: License#: Expiration:
1, hereby certify that I have read and examined this application, City of Arlington Municipal Code, Standard Plan &Specifications. Performance of the
proposed work shall follow all applicable laws and regulations.The owner/applicant shall assume full and complete responsibility for said work and shall
be responsible for the acquisition and compliance of all applicable permits and/or authorizations which may include,but not limited to, Right of Way
Permit,WSDW Hydraulic Project Approval(HPA),WSDOE Notic of Intent(N01),National Pollutant Discharge Elimination System (NPDES),Army Corp.of
Engineers Permits,the requirements ofthe End gered Speci ct,and thX6Forest Practices Application(FPA).
Signature
Print Name: Date: 1 o Z
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