1801BFUM.3_ROW_EDM_0188__ROW Application.pdf— of EVAIt-),
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
/kc. I SCJO PERM IT APPLICATION
PROJECT NAME : 7500 196TH ST SW (SEATTLE HEIGHTS) CONTACT: ARNALDO BLANCO
EDMONDS UG PHASE I
CONTRACTOR: MASTEC NORTH AMERICA, INC. Phone #: (787) 349-2960
Mailing Address: 151 STEWART ST SW, BLDG A,
PACIFIC, WA, 98047
State License MASTENA991KJ
City Business License #:
Fax #:
Email #: ABLANCO@FG-INC.NET
Z Liability Insurance 1X1 Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: RIGHT-01-WAYS OF (109-111) MAIN ST, (110-232) 2ND AVE N (ALLEY),
(107-303) FDMONDS ST & (301-652) 3RD AVE N.
I ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F1 Commercial El Subdivision 0 City Project 0 Traffic Control (Only)
F-1 Multi -Family D Single Family r_1 Other
FX] EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD): FRANCHISED UTILITY -MCI METRO ACCESS TRANSMISSION SERVICES, LLC
Is this permit part of a blanket permit? F1 Yes FX1 N o
� ANY ASSOCIATED PERMITS? 1 4 ENG# I
DESCRIPTION OF PROPOSED WORK (Be Specific): INSTALLATION OF 3254 LF 01: 2" HDPE
CONDUIT, (8) VAULTS AND PULLING OF FIBER CABLE IN THE RIGHT-OF-WAYS OF MAIN ST. 2ND AVE N
(ALLEY), EDMONDS ST & 3RD AVE N. INSTALLATION VIA DIRECTIONAL BORING IN THE RIGH-f,-OF-WAY,
TRENCHING ON ONE SIDEWALK PANEL AND MISSILE BORING ACROSS THE ROAD.
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YESE] NO El Ye
PAVEMENT CUT: Z Yes El No If yes, indicate size of cut: 5' x 5' (0 BOREPITS)
CONCRETE CUT: 0 Yes No If yes, indicate size of cut: 5' X 5' (x8 BOREPITS)
RIGHT-OF-WAY AREA
CLOSURE
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF
Alley 72 Hrs + LF
Parking 72 Hrs + LF
X
LF
aA
SF
I
X
LF
SF
X
LF
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) 2967155-305 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 order 11i th
�permit to be valid.
SIGNATURE DATE 08/24/2018
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE