109112098-15931 72 AVE W.pdf0 \:L L?,11(7.
-,NC. 1 s`) u
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 109112098
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: 15931 72nd 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 T S c/1 of Driveway & 181' E c/I
72nd AVE W 1 3x5 cut in gravel. to install gas service
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year: 1091
PAVEMENT CUT: ❑ Yes ❑ No If yes, indicate size of cut:
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut:
x
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 - DI911e1�➢sl".S,dp.d by Sks P,1111 7/3/2018
I d I cK DN at=Susan 11 " o=Pain itlin DepaNnUS ou=Muniapal
SIGNATURE D1b.201807��3062n=�7 0700=e�nm �-Ds DATE
Deie: 2018.0] 03 08:29:1 ]-0]'00'
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Job #:
Date:
Jurisdiction:
ROW Permit:
Est. Start Date
Est. Duration:
109112098
7/2/18
City Of Edmonds
9/4/18
Puget Sound Energy Gas Pre -Inspect Form
Address:
City / Zip:
Customer:
PM / Inspector:
15931 72ND AVE W
Edmonds, 98026
BEAU FABREGAS 425-501-2122
Jordan Cooper 425-623-5302
Job Description / Scope of Work
From 1 1/4 PE Main (7's 912398) Run New 1 1/8 PE Scat Service 190' (10' Stub & 180' Ext) and
New Construction:
Set A425
Construction Method
PLAT Map:
157070 _
i
I
I
Dc`ve�'
A425 MSA
�I
15931
>I
a.
rI
L
........ _ ............ .
�.
.............................
N Meadowdale RD
Work Location
Size of Cut
Surface Type
7'
S
of CL
Driveway
&
181'
E
I of CL
172nd Ave W
3x5
Gravel
of CL
&
of CL
Of CL
&
of CL
Service Information
Street Information
Job Type
Diameter:
0
Flaggers #:
Arterial:
Altered Residential Svc
EFV:
1-1/8" - 775 - 9995252
Police #:
TCP:
PUGfT
SOUND
® ENERGY
Meter:
A425
Speed Limit:
No Parks #:
Meter Loc:
Trolley Lines:
Mtr Hoods #:
Del Press:
Traffic Signal:
Bus Stop:
Bollards:
I 2.5" # 1 4" # I
ADA Ramps #:I
I Route #'s:
Puget Sound Energy
Traffic Control Supervisor:
Gregory Harwood
Card No. 008997
Card Exp. 08/13/2019
gregory.harwood@pse.com
(425)424-6425
PUGET
SOUND
ENERGY
JOB# 109112098
15931 72ND AVE W, EDMONDS, WA
02nd July, 2018
RESIDENT(S) WILL BE INFORMED
OF ROAD CLOSURE. CREW WILL SHIFT CONES &
EQUIPMENT FOR EMERGENCY VEHICLE ACCESS.
drlve*0
prachi.joshi@pse.com
425-424-6425
` � I
41 616
o #1593
CLOSED o
\ AHEAD47
�a
� o
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. Work area will be7' SCL Driveway & 10'ECL 72nd
Ave W.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
Sheet 1 of 1
LEGEND
®
28" TRAFFIC CONE
WORK PIT
TRAFFIC FLOW
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
ROW ROW
CHANNELIZATION
DEVICE SPACING
MPH
55/70
TAPER
40
TANGENT
80
35/45
30
60
25/30
20
40
24TIN
�IL
L
c
c
18,w
5/8' PE
1994
15917
11j4"per
15931
5/8" PE
1991
5/8' MPE
1997
16123
16121 l 2UU"0MPEI
No electric grid information available Scale 1:620
S156068,Q157070
05-01-2018 Lat\Long=47.8539,-122.3299 OD�PUGETSOUNDENERGY
rma The infotion on the attached maps is subject to change without notice. Puget Sound Energy makes no warranty, e,pressetl or i mphed, concerning
the suitability of this information for any purpose. Recipient agrees to not disclose this confidential information to any oth er person or entity,
unless authorized in writing by Puget Sound Energy. This map is not to be used for determining the actual location of any PSE facilities (,.It 611)."