20191104162947.pdfCity of Edmonds Permit No: _-2tf— C- XXi::M
RIGHT-OF-WAY CONSTRUCTIWN"PERMI I s s u e D a t e
A. Address or Vicinity of Construction: a 0 0, 0 -7 77(o Av C' Is
B. T"e of Work (be specific):
4 1 ":� , 9 ,-
I
C. Contractor: Can
Mailing Address:- ss�cnvz_ AL)
State License #:_'�)tL'c4cr Int
City Business License #:
D. Building Permit # (if applicable):
E. Commercial
Multi -Family
INSPECTOR.
F. PAVEMENT CUT: YES
CONCRETE CUT: KYES
G. 0 Mail Approved Permit
Subdivision
Single Family
El NO
Fj NO
Contact: 0 C-L
Phone: 20 Ca - 4 L_�) 7
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable
El City Project 0 EUC (PUD, VERIZON, PSE, COMCAST, OVWSD)
F-1 Other
- / A
F-1 Call for Pickup
G. SIZE OF CUT / _:�) X S
INDEMNITY. Applicant understands by hislher signature to this application helshe holds 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 but not limited to the defense of any legal proceedings including defense
costs and attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORA TION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED B Y CITY FORCES, A T WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
* 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 wA City codes. All street -cut trench work shall be patched with asphalt or City -
approved material prior to the end of the workday — NO EXCEPTIONS.
* Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
IHAVEREAD THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THAT IMUST MAKE THE PINK COPY OF THE PERMITA VAILABLE ON SITE A TALL TIMES FOR INSPECTIONS
Signature:
(Contractor or Agent)
Date: C) I — 0 q —0 ("
FOR CITY USE ONLY
Approved by: Jaime Hawkins Right-of-way Fee: $160.00 + $15.00
Time Authorized: Void After April /17th / 2906 Disruption Fee/Fund Ill: $0.0
Special Conditions: Restore ROW to like and/or better condition. Maintain 5'11,SpeCtion Fee: 3 @ $50 e—a 77M.
Min. separation from City utilities. Verify clear bore crossings. Call for locates of U/G Total Fee: $325.0
utilities prior to any excavation. Alert affected residents and/or business. Conform to th keceipt No:
approved working drawings and Traffic Control Plan. CDF is required for backfill. Issued by: 922L�:�_
Work hrs. are from 7am-6pm M-F, and 10am-6pm Sat. NO SUNDAY OR FEDERAL HOLIDAY. Plese 611 the number below to schedule
the required inspection(s).
REQUIRED INSPECTIONS:
Call 425-771-0220, Ext. 1326for a 24-hour voice -recorded inspection request line.
FINAL APPROVAL OF PERMITTED WORK: DATE:
Inspector's Signature
C:\Docurnents and Settings\CurtisNy Documents\Fo�s\Engnmg\ROWpermit_.doc
Revised 10/01/03
RIGHT OF WAY CONSTRUCTION PERMIT ROUTING FORM
1pif-
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r— — — — — — — — — — — — — — — — — — — — — — — —
1 Return to Engineering Reviewer
PERMIT #: c:�20 r-,6, DATE RECEIVEM.
WORKADDRESS: '/'Z� 5�' -
CONTRACTOR:
RT = Review Time, Mease ehter the number of hours associated with vour review.
PUBLIC WORKS REVIEW
STREET DIVISION:
'ST6nat1rr—eof Approval
Comments:-
Date Received.
Date:
V L--14iqL30D—f*" _I;tDiF-
C'-
WATER/SEWER:
Signature of Approval
Comments:
Date: RT: -
2s-
PW DIRECTOR:
Signature of Approval
Comments:
Date: R T:
PLANNING REVIEW Date Received:
(REQUIRED ON ALL MRELESS FACILITIES — ceff antennas, unicell, etc.)
Date:
Signature of Approval
PLANNING ONLY: Please notate special conditions on face of permit.
ENGINEERING REVIEWER: RT:
— — — — — — — — — — — — — — — — — — — — — — — — —
COMMENTS made on the attached documents need to be done
with a RED PEN and on ALL 3 COPIES.
DATE AND INITIAL ALL CHANGES OR COMMENTS.
F] FRANCHISE FEE'S REQUIRED: $ (COLLECT PRIOR TO PERMIT ISSUANCE.)
n COPY OF PERMIT TO SANDY CHASE
C:\My Documents\Spellman\Forms\ROW permit routing JMS.doc
Ni Tr
ED
By ENGINEERING
PlIchuck Contractors, Inc
Job # 106168134
Dec 30. 2005
Sheet I of I JCRABB
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202ND PIL SW LL 3: N_4
4-
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FROM
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WORK AREA 3' X 5'
IN PARKING LANE
SIDEWALKSh TO
REMAIN OPEN
CHANNILIZATION oE1qC1 SPAVCING
MPH
TAPER
jTANGENT
5W70
40
so
36/45
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30
160
25/30
20
140
BF
11
4
Notes:
1. All signs and spacing to conform
to the MUTCD and City of Lynnwood
Traffic Control specs.
2. Channelizing devices are 28"
traffic cones.
3. All signs are 48- x 48" B/O unless
otherwise specified.
4. Alert affected residents and businesses.
5. Work area will bel 00' S of C/L of
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202Nd St SW & 15' E & W of C/L o f 76 Ave W.
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CORNEIR
MAINTAIN
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28" IRAFFIC CONE
WORK AREA
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EDMONDS UTILITIES CONSORTIUM
PUGET
SOUND
ENERGY
PILCHUCK
Svc
2006-0002
Address or vicinity of construction:
� 20207 76 AVE W
Description of work to be performed:
Job Notiflcation E-Mail
INSTALL NEW GAS SERVICE @ TRAFFIC INP REQUESTED
02/21/06 AROUND 3:00 PM
REQUESTING INSP.
Pavement or concrete cuts:
Construction Date: 02/21/06
Activil�'(start 02121106)
24o
Other information:
C-\Documents wd Settings\ross\Local Setfings\Temporary Intmet Files\OLKFpse pilchuck job start for edmonds.doc