1801BFUM.14_ROW_EDM_0237__ROW Application.pdfOV EDA,1�,.
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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 9920 EDMONDS WAY (SCRIBER) EDMONDS CONTACT: ARNALDO BLANCO
UG PHASE
CONTRACTOR: MASTEC NORTH AMERICA, INC.
Mailing Address: 151 S1 EW STSW, BLDG A,
PACIFIC, WA, 98047
State License MASTENA991KJ
City Business License #:
Phone#: (787) 349-2960
Fax #: (770) 368-1944
Email #: ABLANCO@FG-INC.NET
Z Liability Insurance Z Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: RIGHT-OF-WAY OF (22044-23107) 100TH AVE W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F-1 Commercial L1 Subdivision E] City Project 0 Traffic Control (Only)
F1 Multi -Family El Single Family F-1 Other
FX_] EUC (PUD, VERIZON, PSE,
CONICAST, OVWSD): FRANCHISED UTILITY -MCI METRO ACCESS TRANSMISSION SERVICES, LLC
Is this permit part of a blanket permit? F-1 Yes Fx] N o
I ANY ASSOCIATED PERMITS'? I
BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific):
INSTALLATION OF 3174 LF OF 2" HDPE
CONDUIT, (6) VAULTS AND PULL FIBER CABLE IN THE RIGHT-OF-WAY OF I OOTH AVE W. INSTALLATION
VIA (3174 LF) OF DIRECTIONAL BORE IN THE RIGHT-OF-WAY.
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YESE] NO [I Year:----]
PAVEMENT CUT: 0 Yes FX_1 No If Yes, indicate size of cut: x
CONCRETE CUT: Z Yes F-1 No If yes, indicate size of cut: 5' X 5' (4x BOREPIT)
T
F:RIG:HT-OF-WAY
CL 0
CLO SURE
AREA
TOTAL
DURATION
(NUMBER OF MONTHS)
idewalk 48 Hrs +
S Si
Alley 72 Hrs +
Parking 72 Hrs +
LF X
LF X
LF
LF
LF
SF
SF
LF X
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 M order I'Or the permit to be valid.
SIGNATURE DATE 09/28/2018
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE