100025122 Permit App.pdfOf ED,1Io
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ROW PERMIT NO.: ENG.
ISSUE DATE:
In/a loco zS/zZ
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: f �'j���L 6Koa)*
CONTRACTOR:g^0ho,w7%j'h dv4l,_� i
Mailing Address: ? oIld 7 AZ =
State License #:
City Business License #:
CONTACT: c�fe-a -7 0 41p //6 P
'Phone #: }zS ,&.70 .3Z0 S'
Fax#: qZS • Z(Q7 _,0(,c)
Email #: J01PTysC P_ _CAtPo)J• fo►rl
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION:170 Z3e"4 T t ,5W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial
❑ Multi -Family
Subdivision
❑ Single Family
Nf EUC (g V RIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
City Project
❑ Other
❑ Yes E�[7No
ANY ASSOCIATED PERMITS? I FLD# ENG#
Traffic Control (Only)
DESCRIPTION OF PROPOSED WORK (Be Specific) : (Y16Mlk O�, &_C6rJ" ri &ems
a n a exl t��-w a� b � Pd�P a�f _rt_ .e A)o, we Larn.�.�
- ♦ / / _ A _
rem
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year:
PAVEMENT CUT:
CONCRETE CUT:
❑ Yes No
❑ Yes No
If yes, indicate size of cut:
If yes, indicate size of cut:
x
x
RIGHT-OF-WAY
AREA
CLOSURE
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 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 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 understan e permit requirements and acknowledge that I must
follow all require nts in or or t e permit t b valid.
SIGNATURE DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
LANE CLOSURE ON A LOW VOLUME ROAD
(NO FLAGGER, TRAFFIC SELF-REGULATING, 35 MPH OR LESS)
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SNOHOMISH COUNTY
Li-MEM TRAFFIC CONTROL PLAN
PUBLIC UTILITY DISTRICT NO 1
PROJECT ALMARK CORPORATION
LOCATION 7718 238TH PL SW EDMONDS WA 98026-8858
ENGINEER C H E L S E A H O L T E DATE 02/06/18 ORDER 100025122
PHONE - -
CELLULAR 425-330 -9043
SPEED
SIGN BUFFER
SPACING
R
A. B tFT)
25
200
55
30
200
85
35
350
120
a
PUBLIC UTILITY DISTRICT NO.1 OF SNOHOMISH COUNTY
LOCATION 7718 238TH PL SW EDMONDS 98026 LYNNWOODAREA
POLE NO. 15465 SE1/4S 31 T 27 R 04 DATE 02/06/18 ORDER 100025122
REASON FOR WORK INSTALL SECO PED RISER ENGINEER HOLTE OPERATION 0060
ALMARK COPORATION DRAFTER U.G. NO. —
SCALE NTS
APPROVED
& DATE PRINTED
DATE WORK COMPLETED
FOREMAN
FEES REQ'D ■ YES
❑ NO
PRIMARY OVERHEAD
❑ RESIDENTIAL
❑ COMMERCIAL
LEO NO.
@S =s
SECONDARY OVERHEAD
NESC VIOLATIONS
BASIC FEE S
■ NO ❑ YES (SEE NOTES)
PERMITS (DATE GRANTED)
❑ TREE TRIM
❑ STATE
'm '=$
METER/CONV. POLE s
PRIMARY UNDERGROUND
❑ RESIDENTIAL
❑ COUNTY
❑ COMMERCIAL
■ EDMONDS
BASIC FEE S
❑
EASEMENTS
LEU NO.
@$ _$
❑ REQUIRED ■ NOT REQUIRED
SECONDARY UNDERGROUND
BASIC FEE S
DATE RELEASED
'@s .=g
UNDERGROUND PLAT
FOREIGN CONTACTS
❑ JPN#
BASIC FEE 8
FT.0 =g
❑JOINT TRENCH FRONTIER &CATV
❑ JOINT BORE FRONTIER & CATV
STREET LIGHTING
❑
(� FT.@S
POLE STENCILING
FROM TO
WORK IN RIGHT OF WAY
❑ PRIMARY
TAKE OFF POLE
❑ SECONDARY
PRE-CONST. REQUIRMENTS
❑ TREE TRIM ❑ PUD LOCATOR
rL FT.@S =s
MISCELLANEOUS FEES
❑ BACKHOE ❑ FLAGGING
VAULT S
E ONE CALL DATE
PERMIT s
390.00
No.
STREET LIGHTING
❑ YES ■ NO
RISER PED s 2060.00
COST ESTIMATE s 501.00
s
M&R
AS -BUILT
S_
GIS
TOTAL DUE s
2951.00
DATE PAID 12/28/2017
GIS QC
M&R
GIS Ph
IJOINT USE
RECEIPT NO.1800011694
LOCATION MAP PAGE 475—A2
SERVICE ORDER NO.
ormw.l s
O EXISTING POLE
0 EXISTING POLE -TO BE REMOVED
• NEW POLE
)10 NEW POLE TO REPLACE EXISTING POLE
DATE
SUBSTATION RICHMOND PARK
CIRCUIT NO. 12-2048 PHASE -
ENGR'S TEL. #
425-670-3205
ENGR'S CELL #
425-330-90431-1
2
SCHEMATIC
NTS
61
CITY OF
PERMIT
AT PLI 15465
EDMONDS
ATTACHED
INSTL 3" SEC RISER ON DIST POLE — T&D IU705
INSTL SM SEC PED 5'SOUTH OF POLE
RUN 45' OF 350KCMIL FROM POLE TO PED
INSTL (3) 4—POS TERM BARS
13811
23901__1 z
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