1310_001.pdf0F
PROJECT NAME:
ROW PERMIT NO. : F-NGZÐN. O Z4q
ISSUE DÄTE:
RIGHT-OF-\ryAY C OI\STRUC TION
PERMIT APPLICATION
2futqY CONTACT:c
2-{¿îlCONTRACTOR:k¿Ëlc 6r{¿nrs ndry' ¿¿¿Phone#z Aoç ?"
Mailing Address:/"ttû tùf. 1(r-tr Fax#:¡¡oP
State License #:Email #z ¡|¡lrr'l /l"r¡¿r*t, C, l¿rt4 (6 fi
City Business License #:Efr,¡an¡nty Insurance S Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION:
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial Subdivision City Project
Other
Traffic Control (OnÐ
I Multi-Family ( sinsre Family tr
I EUc (PUD, vERrzoN, PSE,
coMcAST, OVWSD):
Is this permit part of a blanket permit?
ANY ASSOCIATED PERMITS?
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DESCRIPTION OF PROPOSED WORI( @e Specific) :/ê,*, ,', =,
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WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES NO Wf Year:
PAVEMENT CUT:
CONCRETE CUT:
F Yes
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No If yes, indicate size of cut: x
No If yeso indicate size of cut: 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 (WdC) 296-155-305 and must have certification
verif ing 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.
lndemnity: The Applicant has signed an application which súafes 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 and understand the permit requirements and acknowledge that I must
follow all req for to be valid.
SIG DATE T/T ThZ
or t
NO WORI( SHALL BEGIN PRIOR TO PERMIT ISSUANCE