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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 106342951
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: 18915 94th AVE W
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 10' E c/I of 94th AVE W
& 225' N c/I of 190th ST SW to install gas service (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.
Susan-1 1 — Digile signed ,d Suse ,1111 /� /LO
I d I cK DN at=Susan Sidi[k o=Pen@in DepaNnUS ou=Muniapal
SIGNATURE Re1a��'n'em'��-=��=an=d�0700 �nm�-Ds DATE
Dena: 2018.0] �810.46
52-0�00'
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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Job #:
106342951
Date:
7/12/18
Address:
18915 94TH AVE W
Jurisdiction:
EDMONDS
City/zip:
EDMONDS, 98020
ROW Permit:
Yes
Customer:
Metch Krzeszowski 206-947-8333
Est. Start Date:
Cycle C
PM / Inspector:
Kevin Williams 425-398-6192
Est. Duration:
1 Day (8 Hours)
Job Description / Scope of Work
From 2" PE main run new complete 1 1/8 PE service to single family residential home(10' scat New Construction:
stub with 45' scat extension)set AL-425 meter OL @ Inches No
Construction Method
All Scat / Trenchless
PLAT Map: 161.067 I t
N
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2 MIR 10E\ '
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— — — — ewer 1 1/6 VPE
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Puget Sound Energy
Traffic Control Supervisor:
Gregory Harwood
Card No. 008997
Card Exp. 08/13/2019
gregory.harwood@pse.com
(425)424-6425 p
A.,
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 10' ECL 94th Ave W & 225' NCL
190th St SW.
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JOB# 106342951
18915 94th Ave W Edmonds,WA
July 13,2018
binyam.yallew@pse.com
(425)-424-7809
SHEET 1 of 1
a N
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CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
LEGEND
®
28" TRAFFIC CONE
®
BORE PIT
TRAFFIC FLOW
FLAGGER
WORKVEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
Row
Row