278429 Edmonds ROW App-R.pdf.__.0 \: L L),k , (_),
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PROJECT NAME:
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
CONTRACTOR: Comcast / Cablecom LLC
Mailing Address: 1525 75th St SW
Everett, WA 98203
State License #: CABLEL-11971 DID
City Business License #: NR-021818
ADDRESS OR INTERSECTION OF CONSTRUCTION:
Comcast - Cody Jourden
CONTACT: Cablecorn LLC - Sunshine Crabbs
Phone #: 425-921-8201
Fax #:
Email #: Uorncast - waconstruction_jointuseCcDcable.comcast.com
Cablecorn LLC -
JZLiability Insurance ;Z Bonded
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 [:] Single Family
Sf EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
I ANY ASSOCIATED PERMITS?
F Other
El Yes F-1 No
BLD9 ENG4
DESCRIPTION OF PROPOSED WORK (Be Specific):
REQUESTING PERMISSION TO PROOF/PLILL IN EXISTING 2" CONDUIT FROM EXISTING
PMESTAI I DCATED ON THESOUTH WFqTqinF QESHEI I VAI I EY RD, AT THE INTERSECTION
OF SHELL VALLEY WAY, HEADING NORTHEAST APPROX. 86'TO EXISTING PEDESTAL
LOCATED ON THE NORTH EAST SIDE OF SHR I VAI I FY ROAD- PUSHING NEW.625 CABLE TO
CONNECT INTO EXISTING SYSTEM. ALL UTILITIES TO BE LOCATED PRIOR TO CONSTRUCTION
AND Al I RESTORATION TO MEET OR EXCEED GGITY OF EnMQNn,,;,qTANnARnq
� WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YESE] NOE] Year:
PAVEMENT CUT: E] Yes F-1 No If yes, indicate size of cut: x
CONCRETE CUT: D Yes F 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 Ql��c DATE 7/25/2018
Co(Aractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE