1703MNTQ.006_ROW_EDM_0302__ROW Application.pdf"VC. 1 S'� J
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 6405 218TH ST SW (MOUNTLAKE
TERRACE) EDMONDS UG PHASE
CONTRACTOR: MASTEC NORTH AMERICA, INC.
Mailing Address: 151 STEWART ST SW, BLDG A,
PACIFIC, WA, 98047
State License #: MASTENA991KJ
City Business License #:
CONTACT: ARNALDO BLANCO
Phone #: (787) 349-2960
Fax #: (770) 368-1944
Email #: ABLANCO@FG-INC.NET
❑X Liability Insurance QX Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: RIGHT-OF-WAY OF (8330 - 7100) SW 212TH ST
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑ Single Family ❑ Other
❑X EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD): FRANCHISED UTILITY -MCI METRO ACCESS TRANSMISSION SERVICES, LLC
Is this permit part of a blanket permit? ❑ Yes ❑X No
ANY ASSOCIATED PERMITS?
BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : INSTALLATION OF 5041 LF OF 2" HDPE CONDUIT, (10)
VAULTS AND PULL FIBER CABLE IN THE RIGHT-OF-WAYS OF SW 212TH ST. INSTALLATION VIA (4925 LF) OF DIRECTIONAL BORE IN
THE ROW. (12 LF) OF TRENCHING IN SOFT SOIL & (104 LF) OF MISSILE BORE.
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year:
PAVEMENT CUT: ❑ Yes X❑ No If yes, indicate size of cut: x
CONCRETE CUT: X❑ Yes [—]No If yes, indicate size of cut: 5' x 5' (x5 BOREPITS)
RIGHT-OF-WAY
AREA
CLOSURE
I
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.
SIGNATURE DATE 10/24/2018
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE