1801BFUM.3_ROW_EDM_0190__ROW Application.pdf-1 0� ECIA4(1.
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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 7500 196TH ST SW (SEATTLE FIEIGFITS)
EDMONDS UG PHASE III
CONTRACTOR: MASTEC NORTH AMERICA, INC.
Mailing Address: I I S'I LW A R] S I S W, B LDG A,
PACIFIC, WA, 98047
State License #: MASTENA991 KJ
City Business License #:
CONTACT: ARNALDO BLANCO
Phone#: (787) 349-2960
Fax #: (770) 368-1944
Email #: ABLANCO@FG-INC.NET
Z Liability Insurance 1X1 Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: RIGTIT-OF-WAY OF PUGET DR FROM 835 TO INTERSECTION WITH 88TH AVE W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT
F-1 Commercial 0 Subdivision [:1 City Project F-1 Traffic Control (Only)
F� Multi -Family El Single Family F-1 Other
FXI EUC (PUD, VERIZON, PSE,
CONICAST, OVWSD): FRANCHISED UTILITY -MCI METRO ACCESS TRANSMISSION SERVICES, LLC
Is this permit part of a blanket permit? F� Yes Fx_1 No
ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific): INSTALI,ATION OF 4058 LF OF 2" HDPE CONDUIT,
(7) VAULTS. (2) N4ANHOLES IN THE ROAD AND PULLING FIBER CABLE IN THE RIGHT-OF-WAY OF PUGET DR,
INSTALLATION VIA (3622 LF) OF DIRECTIONAL BORING IN THE RIGHT OF WAY, (124 LF) OF MISSILE BORING INTO
THE STREET AND (312 LF) OF TRENCHING IN SOFT SOIL,
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YESE] NO 0 Year:
PAVEMENT CUT: ED Yes 0 No If yes, indicate size of cut: 5' X 5' (x 14 BOREPITS)
CONCRETE CUT: Z Yes El No If yes, indicate size of cut: 5' x _5' (x2 BOREPITS)
RIGHT-OF-WAY
CLOSURE
AREA
I
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs +
Alley 72 Hrs +
LF X
LFJ
LF
SF1
LF
JX
SF
Parking 72 Hirs +
LF
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) 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 afforney 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 requireiiiciiis 11i ordc,�i'or the perilill to be valid.
SIGNATURE DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
09/06/2018