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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 106341813
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: 7405 176 ST SW
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 725' E c/I of 72nd AVE W &
12' S to 12' N c/1 of 176th ST SW 2 3x56 concrete 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.
Susan-1 1 - Digiie signed ,d Suse ,1111 /��/LO
I d I cK DN at=Susan 11 " ,=di,nitlin DepaNnUS ou=Muniapal
SIGNATURE D1b.201806��5131n=4 0700=e�nm �-Ds DATE
Deia: 2018.06 25 13:15 34-0�'00'
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Job #:
Date:
Jurisdiction:
ROW Permit:
Est. Start Date
Est. Duration:
106341813
6/18/18
Edmonds
8/27/18
1-112 Days
Puget Sound Energy Gas Pre -Inspect Form
Address:
City / Zip:
Customer:
PM / Inspector:
7405 176TH ST SW
EDMONDS, 98026
MICHAEL & Kari Stelma (425)478-8361
Jordan Cooper 425-623-5302
Job Description / Scope of Work
From 2" STW IP 12'S (2267-1960) Run New Scat 1 1/8 PE Service 280' ( 40' Stub & 240' Ext) and
New Construction:
Set A630 OL On Single Family Home.
Service Will Be Installed In Shared Driveway.
Please See
Construction Method
City Of Edmonds GIS Map. 50'ROW
All Scat / Trenchless
PLAT Map: 159070
t
N
7405
106341813
7325
A630 MSA
7401
1-1/8" PE
24" EXISTING Water
1800 EFV
EXISTING Sewer and Manhole
EXISTING StorrnWater
P/L
P/L
— — — — — — — — — — — — — — — — — — — — — — — — — — —
— —
— — — — — — — — — 176th St SW — — — —
— — — — — — —
— — — — — — —
— — — — — — —
— — — — — — — — —
..........:..........:.........:..................:.... ...:...
....:... ...:........:..._
.................... ........... ................... ................ ......... ..........
.........,.......... ................... ......... .............................................. --2'
:-E�IST!•NGCzAS
STW-IP
MAl .......
MAIN IT t C/L
.........................................................................................................
.. ..
. . . . . .
... ... .. .....
. . . . . . . .
Work Location
Size of Cut
Surface Type
725'
E
of CL
72nd Ave W
&
12'
S
of CL
176th St SW
3x5
C
725'
E
of CL
72nd Ave W
&
12'
N
of CL
176th St SW
3x5
C
of CL
&
of CL
Service Information
Street Information
Job Type
Diameter:
1-1/8" PE
Flaggers #:
y
Arterial:
N
New Residential Svc
EFV:
1-1/8" - 1800 - 9996741
Police #:
N
TCP:
y
PUGET
SOUND
ENERGY
Meter:
A630
Speed Limit:
25
No Parks #:
y
Meter Loc:
03 - OL
Trolley Lines:
N
Mtr Hoods #:
N
Del Press:
6" W.C.
Traffic Signal:
N
Bus Stop:
N
Bollards:
1 2.5" # 4" #
ADA Ramps #:I
N
I Route #'s:
I N
Puget Sound Energy
Traffic Control Supervisor:
Gregory Harwood
Card No. 008997
Card Exp. 08/13/2019
gregory.harwood@pse.com
LO
0
r,
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
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 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 maior roadways will be from 9 a.m. to 3 n.m.
PUGET
SOUND
ENERGY
JOB# 106341813
7405 176TH ST SW, EDMONDS, WA
6/20/2018
ryan.perkins@pse.com
425-424-6621
SHEET 1 of 2
a
28" TRAFFIC CONE
®
WORK PIT
TRAFFIC FLOW
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
ROW
ROW
Puget Sound Energy
Traffic Control Supervisor:
Gregory Harwood
Card No. 008997
Card Exp. 08/13/2019
gregory.harwood@pse.com
LO
0
RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
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 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. Work area will be Work area will be 12' SCL of
176th St SW & 725' ECL of 72nd Ave W.
PUGET
SOUND
ENERGY
JOB# 106341813
7405 176TH ST SW, EDMONDS, WA
6/20/2018
ryan.perkins@pse.com
425-424-6621
SHEET 2 of 2
LEGEND
®
28" TRAFFIC CONE
®
WORK PIT
TRAFFIC FLOW
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
ROW
ROW