100023353 Permit App.pdfof EUAtO
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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: -ACE PJ/o tn��E
CONTRACTOR:
Mailing Address: I I( o.1
J � v SJJC
State License #:
City Business License #:
CONTACT: �n1oi2.e..A ItiE� S o�►
Phone #: 1125 78 -� el-3
Fax #:
Email #: at n d'so/0 cJ $nl o q' C owl
❑ Liability Insurance Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 55.5 -f!,
fi v t- N
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial
❑ Multi -Family
Subdivision
❑ Single Family
EUC (PUD, VERIZON, PSE,
C MCAST, OVWSD):
Is this permit part of a blanket permit?
City, Project
❑ Other
❑ Yes [� No
ANY ASSOCIATED PERMITS? BLD# ENG#
Traffic Control (Only)
DESCRIPTION OF PROPOSED WORK (Be Specific) : `R2 p1r,ar-4 1� `OL erQC -e'
loco 2335
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year:
PAVEMENT CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
RIGHT-OF-WAY
AREA
CLOSURE
I
TOTAL
DURATION
(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 sliall be
patched with asplialt 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 may be 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/9%fd. r for the permit to be valid.
SIGNATURE C/ DATE % / 7 7
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
L
LANE CLOSURE ON A TWO-LANE LOW -VOLUME ROAD
(ONE FLAGGER OPERATION)
OAD
W20-1 RWORK =
AHEAD
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ONE LANE
W20-4 ROAD
AHEAD
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SNOHOMiSH COUNTY N
N
EFFLFIE TRAFFIC CONTROL PLAN E
Y)
C
PUBLIC UTILITY MSTRICT HO 1 ��
H
PROJECT REPLACE B/O POLE a
LOCATION 555 6TH AVE N °I
0
ENGINEER ANDREA NELSON DATE 11/20/17 ORDER 100023353 0
3'
PHONE 425-783-4394 };
CELLULAR 425-512-3526 J'
SPEED SIGN BUFFER
SPACING
A, B,C (FT)
FT
25
200
55
30
200
85
35
350
120
40
350
170
45
500
220
50
500
280
55
500
335
D PUBLIC UTILITY DISTRICT NO.1 OF SNOHOMISH COUNTY
LOCATION 555 6TH AVE N. EDMONDS LYNNWOODAREA
POLE NO. PLI # 750 SW1/4S 24 T 27 R 3 DATE 11/6/17 ORDER 100023353
REASON FOR WORK REPLACE B/O POLE ENGINEER A.NELSON OPERATION 0030
DRAFTER U.G. NO.
SCALE 1"=100'
APPROVED
& DATE PRINTED
DATE WORK COMPLETED
FOREMAN
FEES REQ'D [I YES ❑NO
PRIMARY OVERHEAD
❑ RESIDENTIAL
❑ COMMERCIAL
LEO NO.
SECONDARY OVERHEAD
BASIC FEE 8
'@s '=$
METER/CONV. POLE s
PRIMARY UNDERGROUND
❑ RESIDENTIAL
❑ COMMERCIAL
BASIC FEE 8
LEU NO.
NESC VIOLATIONS
■ NO ❑ YES (SEE NOTES)
PERMITS (DATE GRANTED)
❑ TREE TRIM
❑ STATE
❑ COUNTY
■ CITY
EASEMENTS
La _$
❑ REQUIRED ■ NOT REQUIRED
SECONDARY UNDERGROUND
BASIC FEE S
DATE RELEASED
@$ .=$
UNDERGROUND PLAT
FOREIGN CONTACTS
BASIC FEE 8
& FT.@S =S
■ JPN#
❑ JOINT TRENCH FRONTIER & CATV
STREET LIGHTING
q FT.@S =S
[]JOINT BORE FRONTIER & CATV
❑
POLE STENCILING
FROM TO
WORK IN RIGHT OF WAY
❑ PRIMARY
❑ SECONDARY
TAKE OFF POLE
PRE-CONST. REQUIRMENTS
❑ TREE TRIM ❑ PUD LOCATOR
❑ BACKHOE ■ FLAGGING
N ONE CALL DATE
q FT.@S '=S
MISCELLANEOUS FEES
VAULT 8
PERMIT S
No.
STREET LIGHTING
$
S
❑ YES ■ NO
S
M&R
AS -BUILT
s
GIs
TOTAL DUE S
DATE PAID
GIs QC
M&R
GIs Ph
JOINT USE
RECEIPT NO.
LOCATION MAP PAGE 454 F-6
SERVICE ORDER NO.
Ifigaillmal
O EXISTING POLE
X EXISTING POLE -TO BE REMOVED
• NEW POLE
NEW POLE TO REPLACE EXISTING POLE
DATE
SUBSTATION 5CR-5 CORNER
CIRCUIT NO. 12-1283 PHASE 1.2.3
ENGR'S TEL. #
425-783-4394
ENGR'S CELL #
425-512-3526
OA POLE ID# 750
SET 55' POLE W/ GRNDS (NO110) SS -SET 12.5' DEEP
INSTALL 30 DE ASSEMBLY (12F310)- USE 13' ARMS
INSTALL 10 DE ASSEMBLY 02V109)-MOVE TO END OF ARM P
INSTALL (1) 3/8" DWN GUY- USE EXISTING AHR
RMV 100 KVA OH XFMR
UTC # 100-337
SER#-------------
RMV 100 KVA OH XFMR
UTC # 100-320
SER#-------------
RMV 167 KVA OH XFMR
UTC # 167-527
SER#-------------
MARK REMOVAL TAG BO AND SUSPECT PCB XFMR
INSTALL LBCO MOUNTING BRACKET & FU30A (12F603)
HANG NEW 100 KVA OH XFMR (BA21T)
UTC#-------------
SER#-------------
SEC VOLT
---- \---- \----
HANG NEW
100 KVA OH XFMR (BA21T)
UTC#-------------
SER#-------------
SEC VOLT
♦---- \----
HANG NEW
167 KVA OH XFMR (BA21TS)
UTC#-------------
SER#-------------
SEC VOLT \---- \----
SLACK SPAN PRI& SEC SVCS
XFR SEC OH SVCS
REPLACE EXISTING SEC PED WITH NEW 5-POS PED OU707)
RUN NEW 350 SECONDARY TO PED L= 60'
STRIP, TOP AND ABANDON POLE TO FRONTIER
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