1801BFUM.15_ROW_EDM_0239__ROW Application.pdfC)V-
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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT—OF—WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: ' 00 14 238TH STREET SW (HICKMAN
PARK) EDMONDS UG PHASE 11
CONTRACTOR: MASTEC NORTH AMERICA, INC.
Mailing Address: 1 51 STEWARTSTSW, BLDG A,
PACIFIC, WA, 98047
State License MASTENA99 I KJ
City Business License th
CONTACT: ARNALDO BLANCO
Phone#: (787) 349-2960
Fax #: (770) 368-1944
Email #: ABLANCOgFG-INC.NET
Z Liability Insurance FX Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION. R16HT-OF-WAYS OF (23726-23832) 101ST AVE W & (23916-24324) 1001-1-1
AVE W
I ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT: I
Commercial
F] Multi -Family
Subdivision
El Single Family
City Project
7 Other
Traffic Control (Only)
Fx_1 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?
BLD# ENG9
DESCRIPTION OF PROPOSED WORK (Be Specific):
INSTALLATION OF 2083 LF OF 2"
HDPE CONDUIT, (4) VAULTS AND PULL FIBER CABLE IN THE RIGHT-OF-WAY OF 100TH
AVE W & 10 1 ST AVE W. INSTALLATION VIA (2010 LF) OF DIRECTIONAL BORE IN THE
ROW & (73 LF) OF TRENCHING IN SOFT SOIL.
L)YAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YESE] NOE] Year: I
PAVEMENT CUT: El Yes FX] No If yes, indicate size of cut: x
CONCRETE CUT: Z Yes E] No If yes, indicate size of cut: 5' X 5' (x2 BOREPIT)
RIGHT-OF-WAY
AREA
CLOSURE
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF
Alley 72 Hrs + LF
X
X
LF
LF
LF
SF1
SF
Parking 72 Hrs + LF
I 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
11ollow all requirements in ordgr l'9r the permit to be valid.
SIGNATURE DATE 09/28/2018
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE