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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 106338368
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871 C2
City Business License #: N R-023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 614 7th AVE S
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑iC Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
ANY ASSOCIATED PERMITS?
❑ Yes ® No
BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 19' E - 10' W c/I of 7th AVE S
& 73' S c/I of Cedar St to install gas service 1 3x5 dirt cut & 1 3x5 paving cut 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.
-1 1 - Digile signed ,d Suse ,1111 /��/LO
Susan
Id IcK DNtl'Susan Sidi[k,=di,nitlin DepaNnUS ou=Muniapal
SIGNATURE RD1b. nn= emn2113'0'90935 0700 �nm �-Ds DATE
Dena: 2018.04 23 09.09 35-0�'00'
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Job #:
Date:
Jurisdiction:
ROW Permit:
Est. Start Date
Est. Duration:
106338368
3/30/18
Edmonds
Yes
6/4/18
Puget Sound Energy Gas Pre -Inspect Form
Address:
City / Zip:
Customer:
PM / Inspector:
6147THAVE S#
EDMONDS, 98020
SELECT HOMES GARY 206-730-0670
Kevin Williams 425-691-7573
Job Description / Scope of Work
From 2" PE main run new complete 1-1/8 PE service to single family residence(40' scat stub with
New Construction:
35' plat extension)
Set AL-425 meter
OR @ Inches
Construction Method
Scat ROW / Plat Property
PLAT Map:
164.066
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Cedar
ST
P/L
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II
II
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Will Be used for 612 re -connect
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A
A425 MSA
1-118" PE
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ROW 45 FT
Work Location
Size of Cut
Surface Type
19'
E
of CL
7th AVE S
&
73'
1 S
I of CL
jCedarST
3x5
Dirt
10'
W
of CL
7th AVE S
&
73'
S
I of CL
ICedarST
3x5
Asphalt
of CL
&
Iof CL
Service Information
Street Information
Job Type
Diameter:
1-1/8" PE
Flaggers #:
Arterial:
New Residential Svc
EFV:
1-1/8" - 2600 - 9999144
Police #:
TCP:
Yes
PUCEr
SOUND
FNERGY
Meter:
A425
Speed Limit:
25
No Parks #:
6
Meter Loc:
Trolley Lines:
Mtr Hoods #:
Del Press:
6" W.C.
Traffic Signal:
Bus Stop:
Bollards:
2.5" # 1 4" #
ADA Ramps #:1
1 Route #'s: