1801BFUM.1_ROW_EDM_0234__ROW Application.pdf- . 0, � f: 0 lklt I I
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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 21923 9ST11 W AVE (CORONADO SCP)
EDMONDS UG P1 1ASE I
CONTRACTOR: MASTEC NORTH AMERICA, INC.
Mailing Address: 151 STEWARTS I SW, 13LDG A.
PACIFIC, WA, 98047
State License #: MASTENA991KJ
City Business License
CONTACT: ARNALDO BLANCO
Phone#: (787) 349-2960
Fax 9: (770) 368-1944
Email #: ABLANCO@�FG-INC.NET
--�Liability Insurance Z Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: RIGHT-OF-WAYS OF (100-180) 2ND AVE S, (200-242) DAYTON ST &
(203-721) 3RD AVES
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F] Commercial 0 Subdivision [:] City Pro.ject E] Traffic Control (Only)
n Multi -Family [] Single Family F-1 Other
FXJ EtJC (PUD, VE RIZON, PSI,,
CONICAST, OVWSD): FRANCHISED UTTILITY-MCI METRO ACCESS TRANSMISSION SERVICES, LLC
Is this permit part of a blanket permit? F-1 Yes FX-1 No
I ANY ASSOCIATED PERMITS? BLD9 ENG4 I
DESCRIPTION OF PROPOSED WORK (Be Specific): INSTALLATION OF 3541 LF OF 2" HDPE
CONDUIT. (10) VAULTS AND PULL FIBER CABLE IN THE RIGHT-OF-WAYS OF 2ND AVE S.
DAYTON ST& 3RD AVE S. INSTALLATION VIA (3333 LF) OF DIRECTIONAL BORE IN THE ROW,
(148 LF) OF MISSILE BORE ACROSS THE ROAD & (60 LF) OF -rRENCHING IN SOFTSOIL.
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YESE] NOD Year:=
PAVEMENTCUT: 0 Yes FXJ No If yes, indicate size of cut: x
CONCRETE CUT: E Yes 0 No If yes, indicate size of cut: 5' X 5' (x10 BOREPIT)
RIGHT-OF-WAY AREA TOTAL DURATION
CLOSURE (NUMBER OF MONTHS)
LF
Sidewalk 48 Hrs + LF X I 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 helshe 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 pert -nit requirements and acknowledge that I must
follow all requirements in orde f he permit to be valid.
SIGNATURE :�� DATE 09/14/2018
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE