1801BFUM.3_ROW_EDM_0189__ROW Application.pdfov EVk10
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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 7500 196TH ST SW (SEATTLE HEIGHTS)
EDMONDS UG PHASE 11
CONTRACTOR: MASTEC NORTH AMERICA, INC.
Mailing Address: 1 51 STI- ' WART ST SWI BLDG A,
PACIFIC, WA, 98047
State License #: MASTENA991KJ
City Business License #:
CONTACT: ARNALDO BLANCO
Phone#: (787) 349-2960
Fax #: (770) 368-1944
Email #: ABLANCO@FG-INC.NET
Z Liability Insurance N Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: RIGHT-OF-WAYS OF (209-84 1) CASPERS ST & (10 19-1327) 9TH AVE N.
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F] Commercial El Subdivision E] City Project E] Traffic Control (Only)
F] Multi -Family [:1 Single Family F-1 Other
Eg 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_1 No
I ANY ASSOCIATED PERMITS? I I BLD# ENG# I
DESCRIPTION OF PROPOSED WORK (Be Specific): INSTALLATION OF 3176 LF OF 211 HDPE
CONDUIT, (8) VAULTS AND PULLING FIBER CABLE IN THE RIGHT-OF-WAY OF CASPERS ST & 9TH
AVE N. INSTALLATION VIA DIRECTIONAL BORING IN THE ROW, TRENCHING IN SOFT SOIL AND
MISSILE BORING ACROSS THE ROAD (x2).
[WkS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES [:1 NO 0 Year: I
PAVEMENT CUT: Yes No If yes, indicate size of cut: x
CONCRETE CUT: Yes No If yes, indicate size of cut: 5' X 5' (xl BOREPIT)
RIGHT-OF-WAY
AREA
CLOSURE I
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF
X
LF1
LF
LF
SF
Alley 72 Hrs + LF
X
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 order kli;,�41c pci-nift to be valid.
SIGNATURE DATE 08/30/2018
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE