20171212085755164.pdfOV EE)A40
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 108601194
CONTRACTOR: PSE/infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
StateLicense#: INFRASL871C2
City Business License#: N R-023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Ema"": Susan. Sid ick@pse.com
F-1 Liability Insurance E] Bonded
,557
ADDRESS OR INTERSECTION OF CONSTRUCTION: 4e'�g Main St
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F-1 Commercial F-1 Subdivision El City Project El Traffic Control (Only)
F-1 Multi -Family X Single Family F-1 Other
F EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? El Yes No
ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORIC- (Be Specific) : Work area is approx 321'W C/1 of 6th AVE N &
6' S of alleyway . to cut and cap gas main 1 -3x5 paving and 1 -2x2 paving cut anticipated.
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES [I NOE] Year: 10%
PAVEMENT CUT: Z Yes F-1 No If yes, indicate size of cut: 3 x 5
CONCRETE CUT: F1 Yes Fj No If yes, indicate size of cut: _x_
RIGHT-OF-WAY DURATION
AREA TOTAL
CLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF SF
Alley 72 Hrs + LF X LF SF
Parking 72 Hrs + LF X LF SIT
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.
U�40y �� by S� SW
': _s Z=' 'P'. � E—W, —s—t V�
Susan Sidick P_ 12/12/2017
SIGNATURED..=I&WMOT.57��Tw DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
I
Job#: 108601194
Date: 11/22/17
Jurisdiction: Edmonds
Right of Way Permit? E] YES E] NO
Est. Start Date:
Est. Duration:
PRE -INSPECTION REPORT
Address: 537 Main 5t
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WORK DESCRIPTION: Retire 1114" 57WInactive 5ervice 0 Main 321'WCL 6-th Ave A/ in Alley Construction Method
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109108601194
..in .' Fdmnnd� WA
December 1, 2017
Sheet 1 of 1 brent.pogson@pse.com
(425) 398-6158
BELL ST
LI-001
MAINST
LEGEND
CHANNELIZATION
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Notes:
1. Alsigns and spacing to conform to the MUTCD
and City of Edmonds standards.
2. All sidewalks ' driveways, exits and egresses shall he
completely clear unless otherwise Indicated.
3 Channel4ing devices are 284 traffic cones.
4: Sign.bre can b. amilri—rn of 48' x 4W and shall not
obstruct pedestrian access.
S. Crew Is required to leave a minimum of I I'lor travel ng
lanewidth.
6 * Alert affected residents and businesses.
7 Work to take place between 9 a.m. and 4 p.m.
8: Work area will be approximately 146NCL of Main St &
approximately 321' WCL of 6th Ave N.
9. It used, place NO -PARK sitins 72 hours in advance
of the day that the work is to be done.