100023165 Permit App.pdf.JA-,C-. i 593U.
PROJECT NAME:
CONTRACTOR:
-ROW PERMIT NO.: ENG
o0 W (0s - ISSUEDATE:
RIGHT-OF-WAY CONSTRUCTION
PER -MIT APPLICATION
Mailing Address:
-State .License #:
City Business License #:
CONTACT:
Fax
E -
"U "IA " _K _C'A'
El Liability Insurance El Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: . -s -.
-, \' � SA�
I ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT: —]
FIC-ommercial LI'Subdivision HCity Project Traffic Control (Only)
❑ Multi -Family El Single Family El Other
El E_UC'(PUD, VERMONT, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? El yes NO
ANY ASSOCIATED PERMITS? BLD#' ENG#'-
I)E$ClkRTIONOFPROPOSED WORK. (Be Specifile):— v3A_AC->
)5
f WAS STREET OVERLAYED WITHIN THE LAST IFIVE!(5) YEARS? YES.
PAVEMENT CUT: El Yes No H yes, -indicate size of cut:.
CONCRETE CUT: El Yes No. If yes, indicate size of euf:', - x
RIGHT-OF-WAY DURATION
AREA TOTAL
CLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF SF
Alley 72 Hrs + LF X LF SF
Parking 72 Hrs + LF X LF SF
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: The 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 maybe made against the City of Edmonds or.
any of its departments or employees, including defense costs and attorney fees by reason
of granting this permit.
I have read the above statements and understand the permit requirements and acknowledge that I must
follow all requirements in order for the permit to be valid.
SIGNATURE U DATE 2 `�
C .ntractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
@�(W20-1)
SEE NOTE 1
ONE LANE
ROAD
AHEAD
(W20.-4) SEE NOTE 1
(W2307 A) SEE 1 1
TQ°
TABLE A
SPEED
(MPH)
TAPER LENGTH
(FT)
CONE SPACING
ALONG TAPER
(FT)
OFFSET WI➢TH -
10,
12'
25
100
120
25
30
150
180
30
35
200
240
35
40
270
320
40
45
1 450
540
45
NOTE:
1. DISTANCE BETWEEN SIGNS
SHALL
BE 100' FOR RESIDENTIAL
STREETS (25 MPH), AND
200' FOR ARTERIAL ROADWAYS
2. FLASHING BEACON SHALL
BE
INSTALLED AT EACH SIGN
FOR
NIGHT-TIME USE.
3. DISTANCES MAY VARY AS
APPROVED
BY THE ENGINEER.
4. FLAGGERS REQUIRED TO CONTROL
TRAFFIC WHENEVER THE CONTRACTOR
MUST INTERRUPT TRAFFIC FLOW
TO ACCESS THE WORK SITE WITH
MATERIALS OR EQUIPMENT.
LEGEND:
CONE OR CHANNELIZING DEVICE
(SEE STD 7-14)
y
1
WORK-AREA
TRUCK WITH
FLASHING ❑R WITH
BEACON
30°
TAPER LENGTH
O (TABLE A)
t
SEE NOTE 1,
SEE NOTE 1
SEE NOTE 1
a I KHt- r 1L LOIN I KUL, rL_HIN
2 LANE ROADWAY: ONE LANE CLOSED WITH
ALTERNATING ONE-WAY TRAFFIC AND FLAGGERS
! S�" (W20-7 A)
30"
ONE LANE
ROAD
AHEAD
(W20-4)
30"
ROAD
ONSTRUCTION
AHEAD
(w"24-1)
30'
_ T.
SNOxOYISM COUITv
w O PUBLIC UTILITY DISTRICT NO.1 OF SNOHOMISH COUNTY
LOCATION 1015 BELL ST ED LYNNAREA
POLE NO. 928 SE1/4S 24 T 27 R 03 DATE 10/20/17 ORDER 100023165
REASON FOR WORK REPLACE 45' BO POLE FOR PUD ENGINEER MCALLISTER OPERATION 30
DRAFTER U.G. NO.
SCALE
APPROVED
& DATE PRINTED
DATE WORK COMPLETED
FOREMAN
FEES REQ'D DYES ■ NO
PRIMARY OVERHEAD
D RESIDENTIAL
❑ COMMERCIAL
LEO NO.
SECONDARY OVERHEAD
BASIC FEE S
La I=s
METER/CONV.POLE s
PRIMARY UNDERGROUND
❑ RESIDENTIAL
❑ COMMERCIAL
BASIC FEE s
LEU NO.
NESC VIOLATIONS
❑ NO DYES (SEE NOTES)
PERMITS (DATE GRANTED)
D TREE TRIM
❑ STATE
❑ COUNTY
■ CITY
EASEMENTS
@s 1=$
❑ REQUIRED ■ NOT REQUIRED
SECONDARY UNDERGROUND
BASIC FEE s
La '=s
DATE RELEASED
UNDERGROUND PLAT
FOREIGN CONTACTS
❑ JPN#
BASIC FEE s
q FT.@s '=s
❑ JOINT TRENCH FRONTIER & CATV
❑ JOINT BORE FRONTIER & CATV
STREET LIGHTING
ri FT.@s =s
❑
POLE STENCILINGFROM
WORK IN RIGHT OF WAY
TO
❑ PRIMARY
TAKE OFF POLE
❑ SECONDARY
rL FTA$ =s
PRE-CONST. REQUIRMENTS
MISCELLANEOUS FEES
❑ TREE TRIM ❑ PUD LOCATOR
❑ BACKHOE ❑ FLAGGING
VAULT s
E ONE CALL DATE
PERMIT s
No.
s
STREET LIGHTING
$
❑ YES ■ NO
$
M&R
AS -BUILT
u
TOTAL DUE
DATE PAID
RECEIPT NO.
SERVICE ORDER NO.
GIS QCJ M&R
GIS Ph JOINT USE
LOCATION MAP PAGE 454 H-5
O EXISTING POLE
X EXISTING POLE -TO BE REMOVED
• NEW POLE
NEW POLE TO REPLACE EXISTING POLE
DATE
SUBSTATION MPL
CIRCUIT No. 346 PHASE 1
ENGR'S TEL. #
425-670-3216
ENGR'S CELL #
425-501-1254
N
OA POLE 928
SET 45" BO POLE 1® W AND FRAME PER ASSY 12V109
AND 12V601 INSTL NEW 3/80 D.G AND 8' HELIX AHR L=10
XFR DIST XFMR #37-5975 TO NEW POLE
SEC VOLT
XFR 1 OH PRI AND 1 OH NEUT TO NEW POLE
w i
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