106333874-19220 80 PL W.pdfnF EVA,1(-),
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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 106333874
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871 C2
City Business License #: NR-023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 19220 80th PL W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑X Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit9
ANY ASSOCIATED PERMITS?
❑ Yes ® No
BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 410' N c/I of Sierra Dr
& 14' E to 14' W c/I of 80th PL W to install gas service 2 -3x5 concrete/ grass cuts anticipated
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year: 1063;
PAVEMENT CUT:
CONCRETE CUT:
❑ Yes ❑ No
❑ Yes ❑ No
If yes, indicate size of cut: 3
If yes, indicate size of cut:
x5
x
RIGHT-OF-WAY
CLOSURE
AREA
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
DATE 12/20/2017
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Job #:
Date:
Jurisdiction:
ROW Permit:
Est. Start Date
Est. Duration:
106333874
12/12/17
Edmonds
Yes
2/19/18
1-112 Days
Puget Sound Energy Gas Pre -inspect Form
Address:
City / Zip:
Customer:
PM / inspector:
19220 80TH PL W
Edmonds, 98026
Sally Nguyen 408-890-1826
Jordan Cooper 425-623-5302
Job Description / Scope of Work
From 2" PE IP 14'E (912106) Run New Scat 1 1/8 PE Service To Single Family Home 100'(40'
New Construction:
Stub & 60' Ext)
and Set A425 OL. (50'
ROW)
Construction Method
All Scat I Trenchless
PLAT Map:
162067
2" PE
EXIS1
t
EXISTING Power Over Head
E C/L
.......... ..........
912106
.......... ......
.......
........ .
......... .......... .......... ......... ... ...... .... ..... . . . . .
. . .........
.......... ..........
.......... ...............................
80th P1 W
....
................
I...... . .......
.........
.........
- -
- - - - - - - - - - - - - - -
- - - - - - - -
EXISTING Water
. .......
P/L 1-1/8" PE
P/L
19220 80th PL W
..
........
106333874
A425 MSA
a
00
. .. .
.. . .. . .. . .. . .. . ..
Sierra Or
. ..
Work Location
Size of Cut
Surface Type
410'
N
of CL
Sierra Dr
&
14'
E
I of CL
180th P1 W
3x5
C/G
410'
N
of CL
Sierra Dr
&
14'
W
I of CL
180th PI W
3x5
C/G
Of CL
&
I of CL
I
Service Information
Street Information
Job Type
Diameter:
1-1/8" PE
Flaggers #:
y
Arterial:
N
New Residential Svc
EFV:
1-1/811- 2600 - 9999144
Police #:
N
TCP:
y
I
PUCET
SOUND
ENERGY
Meter:
A425
Speed Limit:
25
No Parks #:
y
Meter Loc:
03 - OL
Trolley Lines:
N
Mtr Hoods #:
N
Del Press:
16" W.C.
Traffic Signal:
N
Bus Stop:
N
lBollards:
1 2.5" # 1 4" # I
I ADA Ramps #:1
N I
Route #'s:
I IN
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
80TH PL W
X'
W20-7A
Notes:
1. All signs and spacing to conform to the MUTCD
and City of Edmonds standards.
2. All sidewalks, driveways, exits and egresses
shall be completely clear unless otherwise indicated.
3. Channelizing devices are 28" traffic cones.
Use traffic drums (barrels) with steady burning
Type C lights on all State Routes and Hwys.
4. Sign size can be a minimum of 36" x 36" and shall
not obstruct pedestrian access.
5. Crew is required to leave a minimum of 11' for
traveling lane width.
6. Alert affected residents and businesses.
7. Work to take place between 9 a.m. and 4 p.m
unless otherwise specified. All work for arterials
and major roadways will be from 9 a.m. to 3 p.m
8. Bore pits will be from 14' ECL to 25' WCL of 80th PI W &
410' NCL of Sierra Dr.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
#19220
RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
u� r
o �y
•
receiving o
pit \
12 12
521
O
r—
Q
)9
01
0
0
v
ONE LANE C
ROAD j
AHEAD
0
0
SIERRA DR
"ROAD
WORK
AHEAD
Puget Sound Energy
Traffic Control Supervisor:
Gregory Harwood
Card No. 008997
Card Exp. 08/13/2019
gregory.harwood@pse.com
(425)424-6425
i(.a A
PUGET
SOUND
ENERGY
Jmoo# 106333874
19220 80th pl W, Edmonds, 98026
12/20/2017
safaa.neema@pse.com
(425) 424-6425
Sheet 1 of 2
LEGEND
®
28" TRAFFIC CONE
7/71
BORE PIT
TRAFFIC FLOW
FLAGGER
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
80TH PL W
�a
X.
receiving o0
NZ
pit \
#19220 `
W20-7A
12 112
VIQ
O
O
t—
Notes:
1. All signs and spacing to conform to the MUTCD
and City of Edmonds standards.
2. All sidewalks, driveways, exits and egresses
shall be completely clear unless otherwise indicated.
3. Channelizing devices are 28" traffic cones.
Use traffic drums (barrels) with steady burning
Type C lights on all State Routes and Hwys.
4. Sign size can be a minimum of 36" x 36" and shall
not obstruct pedestrian access.
5. Crew is required to leave a minimum of 11' for
traveling lane width.
6. Alert affected residents and businesses.
7. Work to take place between 9 a.m. and 4 p.m
unless otherwise specified. All work for arterials
and major roadways will be from 9 a.m. to 3 p.m
8. Bore pits will be from 25' WCL of 80th PI W & 410' NCL
of Sierra Dr.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
0
0
ONE LANE
p
� ROAD
j
AHEAD
0
0
SIERRA DR
'ROAD ,
WORK N
AHEAD
Puget Sound Energy
Traffic Control Supervisor:
Gregory Harwood
Card No. 008997
Card Exp. 08/13/2019
gregory.harwood@pse.com
(425)424-6425
i(.a A
PUGET
SOUND
ENERGY
Jmoo# 106333874
19220 80th pl W, Edmonds, 98026
12/20/2017
safaa.neema@pse.com
(425) 424-6425
Sheet 2 of 2
LEGEND
®
28" TRAFFIC CONE
7/71
BORE PIT
TRAFFIC FLOW
FLAGGER
WORK VEHICLE
SIGN LOCATION
WARNING FLAG