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PROJECT NAME:
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Mailing Address:
ROW PERMIT NO. : ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTIOII
PERMIT APPLICATION
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i/,er,r¿CONTACT:
Phone #
Fax
State License#z €SíT,A lrLL tg 77ón,
City Business License #:bility Insurance
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ADDRESS OR INTERSECTION OF CONSTRUCTION:
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RO\ry WORK ASSOCIATED \ryITH THE FOLLOWING TYPE OF PROJECT:
Commercial Subdivision
Multi-Famity ñinet"Family
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Is this permit part of a blanket permit?
City Project
Other
--klYes L_l No Job Number
Traffic Control (Only)
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ANY AS SOCIATED PERMITS?
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DESCRIPTION OF PROPOSED WORK (Be Specific) :FcÐ cz/.,,
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WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES NO vfYear:
PAVEMENT CUT:
CONCRETE CUT:
I Yes
I ves
Ifyes, indicate size ofcut: xt"
ú,,If yes, indicate size of cut:x
RIGHT-OF.\ryAY
CLOSIJRE
AREA TOTAL
DTIRATION
(¡{LMBER 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
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 certifrcation
verifying completion of the required training in their possession.
*Restoration is to be in accordance with City codes and Stapdards. All street-cut trench work shall be
patched with asphalt or City approved material prior to the end of the workday - NO EXCEPTIONS.
INDEMITY: The Applicant has signed an application which states he/she hold the Cib'of Edmonds
harmless from irÍuries. 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 bi reason of srantins this permit.
I have read the above statements and understand the permit requirements and acknowledge that I must
follow all requirements for the permit to be valid.
DATE
ntractor or Agent
SIGNATT]RE
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUA¡ICE
CITY OF EDMONIDS
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STATUS: ISSTIED
I2I 5TH A\iENL]ENORTH - EDMONDS, WA 98020
PHONE: (425)771-0220 - FAX: (425)771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
ENG2019 0346
RIGHT OF WAY PERMIT (l-Single Family)
Permit Number: ENG20 I 90346
Job Address:730 CARY RD, EDMONDS
Expiration Date: 07 /22 12020
Location:
CONTRACTORAPPLIC,{NÏ'
THELERENCOMPANY
CYO TOM LEREN
PO BOX 12863
MILLCREEK, WA 98082
STROMME CONSTRUCTION LLC
C/O PAI]I, STROMME
9623 8TH AVE NE
SEATTLE, WA 981I5
(206) 6s0-7378
LICENSE #: STROMHISTTCM EXP: 03/29 /2020
JOB DNìCRIPTION
ASSESSED VALUE:
SIDEWALK: ( 0X0 )
PARKING: ( 0X0 )
ALLEY: ( 0X0 )
$O.OO PROPERTY AREA:
DURATION IN MONTHS: O
DURATION IN MONTHS: O
DURATION IN MONTHS: O
0
FEE: $0 00
FEE: $0 00
FEE: $0.00
STREET DISRUPTION TRENCHCUT:. ( 0X0 )
YEAR OF OVERLAY: 0 FEE: $0.00
DIS RIJPTION INFORMATION
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EXTEND SEWER LATERAL, INSTALLNEV/ DRI\EWAY AND OTHER UTILITIES AS PERMITTED V/ITH SINCLEFAMILY
HOME.
INDEMMTY The Applicant has signed an application which sÍates he/she holds the City of Edmonds harmlessfrom injuries,
damages or claims of any kind or description y,hatsoe'tter,foreseen or unforeseen, that may be made againsî the City of Edntonds or
any ofits departments or employees, including buf not limiled to the defense ofany legal proceedings including defense cosls and
atlorneyfees by reason ofgranting lhis permil.
T}IECONTRACTOR IS RFSPONSIBLEFOR WORKMANSHIP AND MATFRIALS FOR A PFRIOD OF ONEYEAR FOLLO\ilING TTìE FINAL
INSPECTION AND AC CPTANCE O F TTIEWORK
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 (WAQ 296-155-305 and must have certification verifying conrpletion ofthe required training in their
possesion.
Restoration is to be in accordance with City codes. All street-cut trench work shall be patched with asphalt or Cify approved
material prior to the end of the workday- NO Ð(CEPTIONS.
Three sets of construction drawings of proposed work are required with the permit application.
CALL DIALA-DIG (l -800-424-5555) BEFORE A¡IY D(CAVATION
CALL FOR TNSPECTION (425) 7 7 t -0220 Ð(T. I 326
24 HOf]R NOTICEREQTIIRH) FOR ALL INSPECTION REQT]ESTS
DATE
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THIS APPLICATION IS NOTA PERMITUNTL SIGNED BY THE CIry ENG]NEER ORHIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED-
Printcd Ju 201
{PPLI(],{TION APPROVAL
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STATUS: ISSUED 8NG20190346
o Restore ROV/ to City standards
¡ Call for locates of underground utilities prior to any e>cavation.¡ Conformto approved working drawings and Traffic Control plan.. Utilrty patch restoration to be in accordance with Edmonds Standard detail 82.3¡ Maintain erosion & sedimentation control. Keep street clean.¡ Traffic Control per approved plan and MUTCD. Refer to City of Edmonds traffic control requirements.¡ Three feet of clearance around fìre hydrants, standpþes, P.I.V.'s, manholes, water meters, blowoffs, cleanouts and valves shall
be maintained.
¡ A 6" cleanout with 12" locking cast iron lanphole cover is required at the property line.¡ Condition ofthe existing lateral to be verified by the City's Public Worla Dept. to obtain approval for reuse. Contact Rlnronds
Sewer Divis io n aÍ 425-77 I -0235.. Easement and/or permiss ion from adjacent property owner is required prior to entry/work within adjacent property.. Applicant shall repair/replace all damage to utilities or frontage improvements in Cþ right-oÊway per City standards that is
caused by or occurs during the permitted project.¡ Sound/l'{oise originating fromtemporary construction sites as a result of construction activity are e>empt fromthe noise limits
of ECC Chapter 5.30 onþ during the hours of 7:00amto 6:00pm on weekdays and l0:00am and 6:00pm on Saturdays, ercluding
Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must cornply with the
noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.. Applicant, on behalf ofhis or her spouse, heirs, assigns, and successors in interests, agrees to indemni|, defend and hold
harrnless the City of klmonds, Washington, its officials, employees, and'agents from any and all claims for damages of
whatever nature, arising directþ or indirectþ fi'omthe issuance ofthis permit. Issuance ofthis permit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance not limit in any way the City's ability to enforce any ordinance
provision.
¡ E-F¡osion ControlMobilization
¡ ÞTrafüc Controlr BSewer lateral Installation
o ESewer l¿teral Pressure Testr EEngineering Final
PARTIALINSPECTION
PARTIALINSPECTION
FINA L INSPECTION APPROVED
DATE:-
DATE:-
DATE:
INITIAL:NOTES:_
NOTES:_INITIAL:
IMTIAL:
RIGHT OF WAY PÐlìMIT (l-Single Farnily)
(]ONDITIONS
INSPE('TIONS