21-102537-AD-WHV-06-23-2021-V2.1Bulletin #080 – March 29, 2021 Page 1 of 2 k:\Handouts\ Work Hour Variance Request
Location of Work (for work on both public & private property; complete both sections):
Private Property (Address/Parcel #): ______________________________________________________________
Public Right-of-Way (Street/Cross Street): _________________________________________________________
Date(s) of Proposed Work: _____________________________________________________________________________
Hours of Proposed Work: ______________________________________________________________________________
Description of Proposed Work & Equipment Involved: _____________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Names & phone numbers of TWO contacts that will be available during proposed work hours:
1) ____________________________________________ (____ ____ ____) - ____ ____ ____ - ____ ____ ____ ____
2) ____________________________________________ (____ ____ ____) - ____ ____ ____ - ____ ____ ____ ____
Reason proposed work must be completed outside of regular work hours:
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Provide a brief explanation of why the work will not result in substantial adverse impacts to surrounding properties:
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
See the second page for additional application questions.
APPLICANT INFORMATION
NAME PRIMARY PHONE
BUSINESS/ORGANIZATION ALTERNATE PHONE
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
WORK HOUR VARIANCE REQUEST
COMMUNITY DEVELOPMENT DEPARTMENT
33325 8th Avenue South
Federal Way, WA 98003-6325
253-835-2607, permitcenter@cityoffederalwaycom
www.cityoffederalway.com
FILE NUMBER ____ ____ - ____ ____ ____ ____ ____ ____ DATE
Bulletin #080 – March 29, 2021 Page 2 of 2 k:\Handouts\ Work Hour Variance Request
TO BE COMPLETED BY APPLICANT
Provide a brief explanation of why the exception is necessary to avoid undue delay of project completion and/or long-
term inconvenience or disruption to the public.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
______
1)Will the following criteria be met in accordance with FWRC 19.105.040(3)?
Yes No
Will written notice be mailed at least seven days in advance of the work to owners and occupants of
property located within 300 feet of the project boundary?
Will a notice board that includes construction hours, description of construction activities, mitigation
measures, and two 24 hour project contacts for the duration of the project be posted at the project site?
2)If answered no to above questions, explain what methods of a notice will be provided, or why a notice is not necessary.
Please Note: This request will not be processed unless accompanied by the payment of the application fee.
TO BE COMPLETED BY STAFF
1)Right-of-way requests reviewed by Public Works?
Yes No
2)Notification Requirements Waived?
Yes No
3)Conditions of Approval
Yes No Conditions Attached: Yes No
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
In accordance with FWRC 19.105.040(2)(a), this application is hereby:
Approved Denied
_____________________
Community Development Director Date
Digitally Signed June , 2021, at PM