100028043 Permit App.pdfof EDA,10
0
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: Nb {gyp q6c 1 aG o3`=
CONTRACTOR: S,�InaM�S�► G�nih pub
Mailing Address:
State License #:
City Business License #:
CONTACT: L � S Mq-,rJ o
Phone #: tA 1 V�o - -5;04
Fax #:
Email #: LF A LV ARADOCMIA LLF Ro (2_ 5vo eaa' co •''�
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 1 138 a L� U , e L,-, 9L_ F-,L : J5/ WA q 8--2o
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑ Single Family
X EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
❑ Other
❑ Yes ❑ No
ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : '9e f1kce_ 4 reAOG�4e-
�a.0o' 1, Po►e °"t1 guy w.rc }o -ove_ 15/ SW �� eAts 12:. \ocy�.`o�1. 9econJ.cy rises
Q1SSc �.0 qc inS�,��ec� pry new tP°��. �esJt25lz,\ i-o se4-.
C l �S fec�erl }� new, . p� �e 0. mod! V G s cCVj4tce co v ke4 4 pe a sx�
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
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 understand the permit requirements and acknowledge that I must
follow all requirements in order for the permit to be valid.
SIGNATURE N�4I �ILr DATE 0-3 /o'9 / t
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
SNOHO4191 COUNTY
o PUBLIC UTILITY DISTRICT NO.1 OF SNOHOMISH COUNTY
LOCATION 18824 SOUND VIEW PL EDMONDS WA 98020 LYNNWOODAREA
POLE NO. 120034 SE1/4S 13 T 27 R 3 DATE 03/16/18 ORDER 100028043
REASON FOR WORK PUD TO REPLACE BO POLE ENGINEER ALVARADO OPERATION 30
PL1 120034. DRAFTER U.G. NO.
PUD MAINTENANCE SCALE 1" = 100'
APPROVED
& DATE PRINTED
DATE WORK COMPLETED
FOREMAN
FEES REQ'D ❑ YES ■ NO
PRIMARY OVERHEAD
❑ RESIDENTIAL
❑ COMMERCIAL
LEO NO.
SECONDARY OVERHEAD
BASIC FEE S
@$ '=$
METER/CONY. POLE s
PRIMARY UNDERGROUND
❑ RESIDENTIAL
❑ COMMERCIAL
BASIC FEE 8
LEU NO.
NESC VIOLATIONS
■ NO ❑ YES (SEE NOTES)
PERMITS (DATE GRANTED)
❑ TREE TRIM
❑ STATE
❑ COUNTY
■ EDMONDS
EASEMENTS
@$ '=$
❑ REQUIRED ■ NOT REQUIRED
SECONDARY UNDERGROUND
BASIC FEE s
DATE RELEASED
@$ '=$
UNDERGROUND PLAT
FOREIGN CONTACTS
■ JPN# 100028043
BASIC FEE S
FT.@$ '=$
❑ JOINT TRENCH FRONTIER & CATV
❑ JOINT BORE FRONTIER & CATV
STREET LIGHTING
POLE STENCILING
FROM TO
WORK IN RIGHT OF WAY
❑ PRIMARY
TAKE OFF POLE
❑ SECONDARY
PRE-CONST. REQUIRMENTS
❑ TREE TRIM ❑ PUD LOCATOR
(. FT.@$ _$
MISCELLANEOUS FEES
❑ BACKHOE ❑ FLAGGING
VAULT s
■ ONE CALL DATE 03/13/18
PERMIT s
No. 18092608
s
STREET LIGHTING
$
❑ YES ■ NO
$
M&R
}
AS -BUILT
$
GIS
TOTAL DUE
DATE PAID
GIS QC
M&R
GIS Ph
JOINT USE
RECEIPT NO.
SERVICE ORDER NO.
LOCATION MAP PAGE 454 G3
ldr/dy�ial
O EXISTING POLE
EXISTING POLE —TO BE REMOVED
• NEW POLE
NEW POLE TO REPLACE EXISTING POLE
DATE
SUBSTATION MAPLEWOOD
CIRCUIT NO. 12-345 PHASE 1
ENGR'S TEL. #
425-670-3214
ENGR'S CELL #
425-327-5623
PL 1120034
SET 35' POLE 15' SW OF EXISTING POLE 120034, 5.5' DEEP AS STAKED.
INSTALL NEW GUY WIRE & ANCHOR 12' NE AS STAKED.
FRAME NEW POLE PER ASSEMBLY 1U705. INSTALL PED 15' N
OF POLE AS STAKED.
RUN 45' OF 4/0 AL TPX FROM NEW POLE TO PED.
INSTALL #1 SPOOL & TRANSFER EXISTING OH WIRE
SERVING 18824 SOUND VIEW PL COTTAGE. 15' SPLICE WILL BE NEEDED
RMV MAST ON EXISTING POLE THAT FEEDS 18812 DIRECT FROM XFMR#25-25710
TRENCH 12' FROM EXISTING POLE TO NEW PED. SET 12' 2.5" PVC, INTERCEPT WIRE
AT THE BASE OF POLE AND RUN EXISTING SVCE FROM 18812 AND CONNECT IN PED.
STRIP, TOP, AND ABANDON EXISTING POLE TO FRONTIER
\\,\ \18910
18902
SHEET___LOF__L_
LANE CLOSURE ON A LOW VOLUME ROAD
(NO FLAGGER, TRAFFIC SELF-REGULATING, 35 MPH OR LESS)
SOUTH
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NORTH NORTH
SNOHOMISH COUNTY
ERaomD TRAFFIC CONTROL PLAN
PUBLIC UTILITY DISTRICT NO t
PROJECT PUD TO REPLACE BO POLE 120034 & SET SEC RISER
LOCATION 18824 SOUND VIEW PL EDMONDS WA 98020
ENGINEER LUIS ALVARADO DATE 04/03/2018 ORDER 100028043
PHONE 206-670-3214
CELLULAR 206-327-5623
SPEED
SIGN
SPACING
BUTTER
A, B (FT)