100004907 Re-Application.pdfRE -APPLICATION FOR EXPIRED PERMIT 100tm-4907
Of EDtv,I��j ENG2016-0309
ROW PERMIT NO.: ENG
ISSUE DATE:
I/vC. ). S90 PERM11 lf' Il, AP P1[,11CA'111101N
PROJECT NAME: I OC�Op1q 01 O-}
CONTRACTOR: <;�)0jAC, ,.\,<,.M Pv iN
CONTACT:'t' Z 0: (--' L R uJ =Tc�► J
Phone #: 'A -a - `7 <i�Z - H LA I u
Mailing Address: ��.� C'�pX ���� Fax #:
�l c:.. f' .�Ty"
State License #: "1 zJSe Email #:
City Business License #:
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: A3 6'tto t-%E z; r A n) 0
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
[& Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑ Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit pact of a blanket permit? ❑ Yes ❑ No
ANY ASSOCIATED PERNIITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : 1 r,3 p L.X,F,-/ (� t
(Zk A) ►J i • L : �� _ i c U F'c�vJ L 2
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES I I NO I)d Year: I
(z)
PAVEMENT CUT: Yes ❑ No If ,yes, indicate size of cut:
CONCRETE CUT: ❑ Yes ❑ No If ,yes, indicate size of cut:
RIGHT-OF-WAY
AREA II TOTAI,
CLOSURE
Sidewalk 48 Hrs + LF X LF SN
Alley 72 Hrs + LF X LF SF
Parking 72 Hrs + LF X LF SF
DURATION
(NUMBER OF MONTHS)
APPLICANT TO READ AND SIGN
`Traffic control and public safety shall be in accordance with City regulations as required by the City
Engineer. Every flagger must be trained as required by (WAC) 296-155-305 and must have certification
verifying completion of the required training in their possession.
*Restoration is to be in accordance with City codes and Standards. All street -cut trench work shall be
patched with asphalt or City approved material prior to the end of the workday — NO EXCEPTIONS.
Indemnity: I he Applicant has signed an application which states he/she hold the City of
Edmonds harmless from injuries, damages or claims of any kind or description
whatsoever, foreseen or unforeseen, that may be ►nade against tite City of Iad►nonds or
any of its departments or employees, including defense costs and attorney fees by reason
of granting this permit.
I have read the above statement and understand the permit requirements and acknowledge that I must
follow all requ' •emen in order r the permit to be valid.
SIGNATURE �� DATE ' �7 - ��
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Z' it, VP M91.11PIMY CONSTRUCTION OPERATIONS AND ENGINEERING REOUEST
1818 Rev.11/98
TO FROM
REST ORAT ION/VACTOR CREW DEBRA LAWSON 425-783-4414
ADDRESS/LOCATION/POLE NUMBER
214 MAIN ST, EDMONDS / POLE 352
DATE
10•.17-1'7
MAP NO. WORK ORDER NO. TASK NO.
454—F5 100004907 70
POTHOLE AT P1 & P2 TO LOCATE/VERIFY ENDS OF FUTURE 4" CONDUIT.
ONCE LOCATED, PLEASE PROOF CONDUIT. IF GOOD, MARK WITH LOCATOR BALLS
REPAIR CONCRETE/ASPHALT AND MARK LOCATIONS WITH PAINT.
CfIY OF fDMONDS PERMIT ATTACHED
ACIIVAI k/NOTIFY BEFORE STARLING WORK
P1-P2.
SIZE 01-GONI)U11;
I.AGTH 01 C0N1)IJT:
For de -
lomer Signoture
/349
50-20
15-3211
SL-113661-G 1 k-'A,
75-329575
75-329573 '"4
18
28941 n,
customer service for Customer work CUSTOMER
When completed, coil
the PUD of 425-783-1000
Dote or (1-877-783-1000) osk
for Energy Control Dispotch
n WG3 O rile t ,3 /Aop o► I f WM ,_ o
51PROVED BY (COMPLETED BY
D;mri'oulion' While- Deportment Responsible For Work -Return To Originotor Vihen Competed
Conory-Depot tment Responsible For Work -File Copy
IDATE
CREW HOURS
4
glue-GIS, 03, After Work Completion
f ;m-Originolor
SIGN
SPACING
BUFFER
SPEED
IMIT
A, B (FT)
(FT)
25
200
55
30
200
85
35
350
120
SIDEWALK CLOSURE
ALLEY CLOSURE
(PEDESTRIAN DETOUR)
3RD AVE W2 -1ROAD I
WORK I Q SIDEWALK -SED Sp
AHEAD USE OTHER SIDE
I
Ah ALLEY
� P� P2
0-1 Q _ _ BARRICADE, TYP
LI
.I
2 X �� AV N Q
G
I I
I
SIDEWALK
CLOSED
SIDEWALK CLOSED
4— SP-5
USE OTHER SIDE
ROAD
W20-1 <
WORK
AHEAD
ROAD
W20-1 WORK
AHEAD