1801BFUM.1_ROW_EDM_0235__ROW Application.pdf0� ED&10
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ROW PERMIT NO.: ENG.
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
V �__ 0-
C. 11313 PERMIT APPLICATION
PROJECT NAME: 1192i 45TH W AVE (CORONADO SCP)
EDMONDS UG P1 1ASE 11
CONTRACTOR: MASTEC NORTH AMERICA, INC.
Mailing Address: 1 51 STEWAR I S I SW, BLD6 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
Z Liability Insurance Z Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: R[GHT-OF-WAYS OF (305-835) PINE ST.
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
n Commercial LJ Subdivision 0 City Project El Traffic Control (Only)
F-1 Multi. -Family [:1 Single Family F-1 Other
FXI EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD): FRANCHISED UTILITY-PVICI METRO ACCESS TRANSMISSION SERVICES, LLC
Is this permit part of a blanket permit? F-1 Yes FX_1 No
ANY ASSOCIATED PERMITS? FBLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific):
INSTALLATION OF 3273 LF OF 2"
HQPE CONDUIT, (7) VAULTS AND PULL FIBER CABLE IN THE RIGHT-OF-WAY OF PINE
STREET. INSTALLATION VIA (3261 LF) OF DIRECTIONAL BORING IN THE RIGHT-OF-WAY
AND (12 LF) OF TRENCHING IN SOFT SOIL.
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES 0 NOE] Year: ]
PAVEMENT CUT: El Yes Z No If Yes, indicate size of cut: x
CONCRETE CUT: 0 Yes rX� No If yes, indicate size of cut: x
RIGHT-OF-WAY
CLOSURE
AREA
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs +
Alley 72 Hrs +
Parking 72 Hrs +
LF X
LF1
LF
LF
I
SF
LF
X
SF
LF
x
MmEnin
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 permit requirements and acknowledge that I must
follow all requirements in ordcl- I'M t1i lellnittobe valid.
SIGNATURE DATE 09/14/2018
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMITISSUANCE