20170706090914739.pdfU
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ROW PERMIT NO.: ENG,
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 107053997
CONTRACTOR: PSE/infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
StateLicense#: INFRASL871C2
City Business License #: NR-023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Emailil: Susan.Sidick@pse.com
F-1 Liability Insurance D Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 50 Pine St
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F-1 Commercial 0 Subdivision 0 City Project E] Traffic Control (Only)
F1 Multi -Family N SingleFamily F-1 Other
F-1 EUC (PUD, VERIZON, PSI,,
COMCAST, OVWSD):
Is this permit part of a blanket permit? F1 Yes W No
ANY ASSOCIATED PERMITS9 BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific): To extend 2" pe gas main 40 feet to the east side of 216th ST &
Extend N'approx 70'work area is approx 7' E c/1 of Pine St & 54' N C/1 of 216th St sw (1 -3x5 paving cut )
TE c/I of Pine St & 84'N CA of 216th ST SW ( 1- 3x5 paving cut) TE c/l of pine St & 114'N c/1 of 216th ST SW 1 -3x5 paving cut
2 utility potholes at approx 7' E c1l of pine St Also 55'N & 62'N cn of 216th ST SW (2 -2x2 asphalt Guts) see attached pre inspect sheet for additional cuts. total of cuts in paving will be( 8)
I WAS STREET OVERLAYED WITHIIN THE LAST FIVE (5) YEARS? YES El NOE] Year: 107ei I
PAVE MENT CUT: X Yes F-1 No If yes, indicate size of cut: 3 x 5
CONCRETE CUT: F1 Yes F1 No If yes, indicate size of cut: X_
Job #:
Date:
Jurisdiction:
ROW Permit:
Est. Start Date:
Est. Duration:
Puget Sound Energy Gas Pre -Inspect Form
107053997
5/3/17 Address: 50 PINE ST
Ernonds City/ Zip: Edmonds, WA
Yes Customer: DON CUNNINGHAM 206-900-1282
8/7/17 PM / Inspector: Kevin Williams (425) 691-7573
4 Days
Job Description / Scope of Work
FROM 2"MPE IP MAIN ON 216TH ST SW EXTEND 2" MAIN 26'TO EAST AND EXTEND 140'
New Construction:
Yes
NORTH, RUN NEW 2" PE SERVICE TO MULTI
-FAMILY COMPLEX
Construction Method
Scat ROW Plat Property
PLAT Map: 164.064
t
N
�eFT
L
ROW 60'FT
CD
4j
X
2" PEIP
CL
F2_16thSTSW i
6 total cuts for main extension
2' E of E edge paving
22'N CL 216th ST SW 3x5 Asphalt
7� E CL of Pine ST
24: N CL 216th ST SW 3x5 Asphalt
7 E CL of Pine ST
54 N CL216th STSW 3x5 Asphalt
0.
7' E CL of Pine ST
84' N CL 216th ST SW 3x5 Asphalt
7' E CL of Pine ST
114'N CL 216th ST SW 3x5 Asphalt
7' E CL of Pine ST
149'N CIL 216th ST SW 3x5 Asphalt
2 utility pot holes
7' E CL of Pine ST
55' N CL 216th ST SW 2x2 Asphalt
7' E CL of Pine ST
62' N CL 216th ST SW 2x2 Asphalt
Work Location
Size of Cut
Surface Type
edge
&
of CL
of CL
&
of CL
of CL
&
of CL
Service Information
Street Information
Job Type
Diameter:
2" PE
Flaggers #:
2
Arterial:
no
Comercial
EFV:
0
Police #:
no
TCP:
Yes
PUGE7
SOUND
INERGY
Meter:
--- F-T
I
Speed Limit:
25
No Parks#:
Meter Loc:
01 - OFR
Trolley Lines:
no
Mtr Hoods #:
Del Press:
2 PSI
Traffic Signal:
no
Bus Stop:
1
no
113ollards:
12.5" # 1 4" # I
ADA Ramps #:I
no
I Route #'s:
I
RIGHT-OF-W:AY AREA TOTAL DURATION
CLOSURE (NUMBER OF MONTHS)
i Hrs +
Sidewalk 48 Hrs + LF X LF SF
Alley 72 Hrs + LF X LF SF
Parking 72 Hrs + LF I x I JLF 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 for the permit to be valid.
D= -P�� � E�w, S U.
Susan Sidick
SIGNATURE W=16-W 07 30 ff DATE 7/5/2017
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE