1801BFUM.15_ROW_EDM_0238__ROW Application.pdfROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 10014 2.;8*1'11 STRI-11-SW (I 11CK MAN
PARK) IDMONDS UG Ill IASE I
CONTRACTOR: MASTEC NORTH AMERICA, INC.
Mailing Address: 151 STFWARTSTSW, BLDG A.
PACIFIC, WA. 98047
State License 9: MASTENA99 I KJ
City Business License
CONTACT: ARNALDO BLANCO
Phone#: (787) 349-2960
Fax 9: (770) 368-1944
Email #: ABLANCOgFG-INC.NET
Z Liability Insurance FX1 Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: RIGHT -OF -WAYS OF (23029-23726) 100TH AVE W&(10014)238Ti I STSW
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F-1 Commercial F-1 Subdivision F1 City Project 0 Traffic Control (Only)
F1 Multi -Family E:1 Single Family F Other
FX] EUC (PUD, VERIZON, PSE,
CONICAST, OVWSD): FRANCHISED UTILITY -MCI METRO ACCESS TRANSMISSION SERVICES, LLC
Is this permit part of a blanket permit? [] Yes FX] No
I ANY ASSOCIATED PERMITS9
BLD# FNG#
DESCRIPTION OF PROPOSED WORK (Be Specific):
INSTALLATION OF 2534 LF OF 2"
HDPE CONDUIT, (4) VAULTS AND PULL FIBER CABLE IN THE RIGHT-OF-WAYS OF I OOTH
AVE W & 238TH ST SW. INSTALLATION VIA (2534 LF) OF DIRECTIONAL BORE IN THE
ROW.
[:WKS STREET OVERLAYED WITHIN THE LAST FIVE (5) VEARS? YESE] NO [:] Year:
PAVEMENT CUT: 0 Yes FX1 No If yes, indicate size of cut:
CONCRETE CUT: Z Yes El No If yes, indicate size of cut:
x
5' X 5' (x4 BOREPIT)
RIGHT-OF-WAY
AREA
CLOSURE
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X
Alley 72 Hrs + LF X
LF1
LF
LF
SF1
SF
Parking 72 Hrs + 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 in orde-1- fbr the permit to be valid.
SIGNATURE DATE 09/28/2018
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE