278429 Edmonds ROW App (2).pdf.__.0 \: L L),k , (_),
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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 21035 SHELL VALLEY RD EM19 TROY
- JOB # 278429
CONTRACTOR: Cablecom LLC
Mailing Address: 8602 Maltby Rd, Woodinville, WA 98072
State License #: CABLEL-11971 DIP
City Business License #: NR-021818
Comcast - Jourden Lawrence
CONTACT: Cablecorn LLC - Sunshine Crabbs
Phone 4: Sunshine- 360-454-3163 Jourden- 425-921-8201
Fax #:
Email #: Uorncast - waconstructlon_jointuseCcDcable.comcast.com
Cablecom LLC - sunshine.crabbs@cablecomllc.net
JZLiability Insurance ;Z Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 21035 SHELL VALLEY RD
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F-1 Commercial F-1 Subdivision El City Project E] Traffic Control (Only)
F-1 Multi -Family [:] SingleFamily
Sf EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
I ANY ASSOCIATED PERMITS?
F Other
El Yes FX No
BLD9 ENG4
DESCRIPTION OF PROPOSED WORK (Be Specific): REQUESTING PERMISSION TO BORE FROM EXISTING
PEDESTAL ON THE SOUTH SIDE OF SHELL VALLEY RD, AT THE INTERSECTION OF SHELL VALLEY WAY, HEADING NORTHEAST
APPROX. 86'TO EXISTING PEDESTAL BETWEEN 21035 & 21031. PLACE 2" CONDUIT AND PUSH NEW.625 CABLE TO CONNECT INTO
EXISTING SYSTEM. ALL UTILITIES TO BE LOCATED PRIOR TO CONSTRUCTION AND ALL RESTORATION TO MEET CITY OF EDMONDS STANDARDS.
� WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YESE] NOE] Year:
PAVEMENTCUT: R Yes F-1 No If yes, indicate size of cut: 3 x 5
CONCRETE CUT: D Yes R No If yes, indicate size of cut: x
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 + LIT
X
I
LF
I
SF
J
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.
SIGNATURE _C�5c DATE 3/12/2018
4�1 Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE