12.4.18 ROW application.pdfgç
ROW PERMIT NO. : ENG
ISSUE DATE:
RIGHT.OF-WAY C ONSTRUCTION
PERMIT APPLICATION
pRoJEcr NAME: tj,;-/<^f WìVe,ur*, coNrACr:7.>€j L,$þa
CONTRACTOR:Phone#: gA 6 7 - L,Í 337
Mailing Address:Fax #:
Email #: J e 5ec-State License #:a9
City Business License #:n r,ianiuty Insurance I Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION:
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
K
T EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
ANY ASSOCIATED PERMITS?
City Project
Other
Traffic Control (Only)
E ves A*o
BLD#ENG#
Commercial
Multi-Family
Subdivision
Single Family
DESCRIPTION OF PROPOSED WORK (Be Specifïc) :2'{+.5
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PAVEMENT CUT:
CONCRETE CUT:
INo
INo
fl ves
! ves
If yeso indicate size of cut:
If yeso indicate size of cut:
x
Noþ(l Year:wÁS STREET OVERLAYED \ryITHIN THE LA-ST FIVE (5) YEARS? YES
x
e,
RIGHT-OF-\ryAY
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
MA"fyurr( Ct\obw¿- \N¿¿ì5sú'a
APPLICANT TO READ AND SIGN
tTraffic 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 sfaúes 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 cosfs 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.
SIGNATURE DATE
Contractor or Agent
NO \ryORI( SHALL BEGIN PRIOR TO PERMIT ISSUANCE