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107054345 Permit Request Form.pdf
PERMITREQUESTFORM DateofRequest: 06/26/17 Job number: 107054345 98020 8010212thStSWEdmonds Job address: City: Zip: (425)424-6475 AprilJones Project mgr:PM contact #: ______________________ PM email: april.jones@pse.com Estimated job start date: 07/26/17 Estimated job completion date: Description of work to be performed: PermissionrequestedFIRSTCUT-totieintoexisting1-1/4"PEIPlocated21'WC/Lof80th AveW.and298'NofC/Lof213thStSW(cutintoasphalt3'x5')toinstall2"maintoserve theplatofBrackett'sCornerperattacheddrawing. SECONDCUT-tieintoexisting1-1/4"PEIPlocated21'WC/Lof80thAveW.and 184'NofC/Lof213thStSW(cutintoasphalt3'x5')toinstall2"maintoservetheplatof Yes No Pavement cut? 4 3'5' Ifyes,DimensionsofCut:Length Width 2 Howmanycuts? ASPHALT SurfaceType YesNo Require trenching? 4 Ifyes,Dimensionsof trench:LengthWidthDepth Holehog Method of installation: Traffic impact: Yes 4 No Road closed 1 YesNo 4 South Direction? HowMany? Lane closed No Yes Shoulder closed 4 No Yes Sidewalk closed 4 Emergency Contact: DeanLatimer Cell Number: (253)350-6687