1801BFUM.3_ROW_EDM_0191__ROW Application.pdf._� OV F-DAf(-).
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
"'Vc. 1.8913 PERMIT APPLICATION
PROJECT NAME: 7500 196TH ST SW (SEATTLE HEIGHTS) CONTACT: ARNALDO BLANCO
LI)MONDS UG PHASE IV
CONTRACTOR: MASTEC NORTH AMERICA, INC. Phone #: (787) 349-2960
Mailing Address: 151 sTrWATT ST SW, BLDG A, Fax #:
PACIFIC, WA, 98047 (770) 368-1944
StateLicense#: MASTENA991KJ Email #: ABLANCO@FG-INC.NET
City Business License #: X Liability Insurance M Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: RIGHT-OF-WAY OF (8710-7700)196TH ST SW
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F1 Commercial D Subdivision E] City Project R Traffic Control (Only)
F-1 Multi -Family Ll Single Family F] Other
[_X1 EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD): FRANCHISED UTILITY -MCI METRO ACCESS TRANSMISSION SERVICES, LLC
Is this permit part of a blanket permit? [71 Yes FX_1 No
I ANY ASSOCIATED PERMIT I BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific):
INSTALLATION OF 3651 LF OF 2"
HQPE CONDUIT, (7) VAULTS AND PULLING FIBER CABLE IN THE RIGHT-OF-WAY OF
196TH ST SW. INSTALLATION VIA DIRECTIONAL BORE IN THE RIGHT-OF-WAY.
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES L
_J NO 0 Year:
PAVEMENT CUT: El Yes FX_1 No If Yes, indicate size of cut: x -
CONCRETE CUT: Z Yes [:1 No If yes, indicate size of cut: 5' X 5' (x5 BOREPIT(S))
RIGHT-OF-WAY
CLOSURE
AREA
I
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs +
LF
X
LF
SF
Alley 72 Hrs +
LF
X
LF
SF
Parking 72 Hrs +
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 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 figr the permit to be valid.
of,
SIGNATURE DATE 08/3 1/2018
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE