1801BFUM.1_ROW_EDM_0236__ROW Application.pdfOV EVA,1(-).
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGUIT-OF-WAY CONSTRUCTION
/"".'C' )'S90 I"ERMIT APPLICATION
PROJECT NAME: 7500 196TH ST SW (SEATTLE HEIGHTS) CONTACT: ARNALDO BLANCO
EDMONDS UG PHASE III
CONTRACTOR: MASTEC NORTH AMERICA, INC.
Mailing Address: 151 S1 E.WAR I'ST SW, BLDG A,
PACIFIC. WA. 98047
State License #: MASTENA99 I KJ
City Business License #:
Phone#: (787) 349-2960
Fax #: (770) 368-1944
Email #: ABLANCO@FG-INC.NET
Liability Insurance Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: R161 IT -OF -WAYS OF (1009-1139) 9TH AVE S, (22006) 1 OOTH AVE S &
(9901-9809) 220TH ST SW.
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
H Commercial El Subdivision LJ City Project El Traffic Control (Only)
F-1 Multi -Family F] Single Family 0 Other
FX] EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD): FRANCHISED UTILITY -MCI METRO ACCESS TRANSMISSION SERVICES, LLC
Is this permit part of a blanket permit? F-1 Yes FX1 No
I ANY ASSOCIATED PERMITS?
BLD9
ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific): INSTALLATION OF 1296 LF OF 2"
HQPE CONDUIT, (7) VAULTS AND PULL FIBER CABLE IN THE RIGHT-OF-WAYS OF 9TH
AVE S, 100TH AVE W & 220TH ST SW. INSTALLATION VIA (1227 LF) OF DIRECTIONAL
BORE [N THE ROW & (69 LF) OF TRENCHING IN SOFT SOIL.
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES 0 NO 0 Year—, 7--]
PAVEMENT CUT: El Yes FX1 No If Yes, indicate size of cut: — x —
CONCRETE CUT: Z Yes F� No If yes, indicate size of cut: 5' X 5' (x5 BOREPIT)
RIGHT-OF-WAY
H T
AREA
CLOSURE
'L 0
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF1
w
Alley 72 Hrs + LF X LF
arking 72 Hrs + LF X LF
FPC
r ji
I
SF1
SF
I
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
rollow all requirements iii order ror the permit to be valid.
SIGNATURE DATE 09/28/2018
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE