367666-Edmonds permit app.pdf()f EL)AIC) 4
ROW PERMIT NO.: ENG.
ISSUE DATE:
k� RIGHT-OF-WAY CONSTRUCTION
INC. 1 $90 PERMIT APPLICATION
PROJE CT NAME: 17) Le p, .�r CONTACT:
CONTRACTOR: Phone#:
Mailing Address:
Fax #:
State License #: Email#:
City Business License 0 Liability Insurance E] Bonded
ADDRE SS OR INTERSECTION OF CONSTRUCTION:
I ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT: I
Commercial L] Subdivision Ll City Project Ll Traffic Control (Only)
F-1 Multi -Family 9 Single Family F1 Other
1:1 EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? Yes No
ANY ASSOCIATED PERMITS9 BLD# ENGH
. I
DESCRIPTION OF PROPOSED WORK (Be Specific): aAc:c b) �y
POL64
66' T
EET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YESF1 NOD Year: I
PAVEMENT CUT:
CONCRETE CUT:
F1 Yes 0 No
El Yes 0 No
If yes, indicate size of cut: x
if yes, indicate size of cut: X.
RIGHT-OF-WAY
AREA
CLOSURE
TOTAL
DURATION
(NUMBER OF MONTHS)
I
Sidewalk 48 Hrs + LF
X
LF1
SF
Alley 72 Hrs + LF
X
LF
SF
Parlihig 72 Hrs + LF
X
LF
SF
APPLICANT TO READ AND SIGN
*Traffic coiArol arid public safety sliall be iii accordatice witli City regulatioris as required by the City
Erigineer. Every flagger must be trairied as required by (WAC) 296-155-305 and must have certificatiori
verifyirig completiori of the reqUired trairtirig iii tlieir possessiort.
*Restoration is to be iii accordaiice witli City codes and Staiidards. All street -cut tremli work sliall be
patclied witli asplialt or City apl)roved material prior to ttie erid of tlie 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 liave read the above statements aiid uriderstaiid the permit requiremerits arid acktiowledge that I must
follow all requiremerits in or, foi- the 1)errnit to be valid.
DATE
SIGNATURE Contractor 61,-Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
LANE CLOSURE IN �
(WORK ARE
ROAD
W20-1 voRK
ME AD
ONE LANE
W20-4 Rom
MEAD
W20-7A
0
"A
ROAD
VORK
AHEAD
W20-1
kDV4
A ON T
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ICE 0
HE THRC
f
F AN INTERSECTION
UGH ROAD)
W20-1
< ROAD
WORK
AHEAD
AA*>
STOP
SPEED
LIMIT
SIGN
SPACING
A. B,C (F T)
BUFFER
(F T)
25
200
55
30
200
85
35
350
120
40
350
170
45
500
220
50
500
280
55
500
335
-0-
240TH ST SW
0 0 0
W-1
7BUFFER
o I TAPER
0 '-50'MIN
LLj 0 100'MAX
TW20-7A
',
ONE LANE
ROAD W20-4
AHEAD
00 *>
ROAD
WORK W20-1
AHEAD
f SNOHONUSH COUNTY I
[jDUEM TRAFFIC CONTROL PLAN
t MIC UTILITY DISIRICT NO i j
PROJECT REPLACE (2)B/O POLES
LOCATION 23926 84TH AVE W. EDMONDS
ENGINEER ANDREA NELSON DATE 6/2/2017 — ORDER 367666
PHONE 425-783-4394
I c:
I
CELLULAR 425-512-3526
114
Li
LANE CLOSURE ON A LOW VOLUME ROAD
(NO FLAGGER, TRAFFIC SELF —REGULATING, 35 MPH OR LESS)
SPEED SIGN BUFFER
LIMIT SPACING (FT)
A. B (F T)
ROAD 25 200 55
W20-1 m
AMH E ADD
30 200 85
35 350 120
ONE LANE if
W20-4 ROAD
AHEAD
<* 0 0
0
0
0
LLJ
0
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0
LLj >
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< z
0
0
SNOH
O?A SH UNTY
r_'_'_'FLnM TRAFFIC CONTROL PLAN
Lr_
k PUBLIC UTILITY DISTRICT NO I
PROJECT REPLACE (2) Q/0 POLES
LOCATION 23926 84TH AVE W. EDMONDS (POLE A)
ENGINEER ANDREA NELSON DATE 6/2/2017 367666
ORDER 0
PHONE 425-783-4394
CELLULAR 425-512-3526
L
PUBLIC UTILITY DISTRICT NO.1 OF SNOHOMISH COUNTY
LOCATION 23926 84TH AVE W. EDMONDS LYNNWOODAREA
POLE NO. PLI#15301 SW1/4S 31 T27 R4 DATE 5/19/17 ORDER 367666
REASON"FOR WORK REPLACE (2) B/O POLES ENGINEER A.NELSON OPERATION 03
DRAFTER U.G. NO. 3852-2
SCALE J"=100'
APPROVED DATE PRINTED
DATE WORK COMPLETED
FOREMAN
FEES REO'D 0 YES N NO
PRIMARY OVERHEAD
0 RESIDENTIAL
0 COMMERCIAL
LEO NO.
.
SECONDARY OVERHEAD
BASIC FEE 9
,@3
METER/CONV.POLE
PRIMARY UNDERGROUND
0 RESIDENTIAL
0 COMMERCIAL
BASIC FEE 9
LEU NO.
NESC VIOLATIONS
0 NO DYES (SEE NOTES)
PERMITS (DATE GRANTED)
IN TREE TRIM
0 STATE
EICOUNTY
0 CITY
0
EASEMENTS
'@s '= $_
0 REQUIRED E NOT REQUIRED
SECONDARY UNDERGROUND
BASIC FEE 3-
DATE RELEASED
es 8-
-
UNDERGROUND PLAT
FOREIGN CONTACTS
N JPN#
BASIC FEE Z
q FT.@$
OJOINT TRENCH FRONTIER & CATV
OJOINT BORE FRONTIER & CATV
STREET LIGHTING
D
(� FT.@3
POLE STENCILING
FROM TO
WORK IN RIGHT OF WAY
• PRIMARY
TAKE OFF POLE
• SECONDARY
PRE-CONST. REQUIRMENTS
EITREE TRIM 0 PUD LOCATOR
q FT.@$ .=s
MISCELLANEOUS FEES-
0 BACKHOE 0 FLAGGING
VAULT S
0 ONE CALL DATE
PERMIT 3
No.
STREET LIGHTING
0 YES 0 NO
s
M&R
AS -BUILT
s
GIS
TOTAL DUE
GIS QC
M&R
DATE PAID
GIS Ph
JOINT USE
RECEIPT NO.
SERVICE ORDER NO.
LOCATION MAP PAGE 474 J-3
LEGEND:
0 EXISTING POLE
X EXISTING POLE -TO BE REMOVED
0 NEW POLE
)1( NEW POLE TO REPLACE EXISTING POLE
DATE
SU13STATION RICHMOND PARK
CIRCUIT NO. 12-5217 PHASE 1.2.3
ENGR'S TEL. #
1425-783-43941
ENGR'S CELL #
I 425-512-3Z526:U
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(D SET 45- POLE W/ GRNDS- 10' N 4- W (PW2045,NO110)
POLE SET 10'FROM TRAVELED LANE
INSTALL 30 DE (12F310)
INSTALL 10 DE- SOUTH OFF ARM, FU15A
37 INSTALL 10 UG TERM, FU65A
SEE UG DWG #3852-2 (WO#381999)
?F U15 ROUTE EXISTING UG PRIMARY TO NEW
RMV 37 KVA OH XFMR
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INSTALL 30 TANGENT (12F303)
INSTALL 30 VALLEY ARM (12F337)-BOTTOM
INSTALL 336 AAC JUMPERS
RMV ST LT* SL-39112-F
INSTALL 10'ARM (L0504) & 3000k 20OW HEAD (5000625)
ST LT # ---------
SEC VOLT ---- \ ---- \---- Ar rw k 2 1 SE. C I f- A
INSTALL SPAN GUY -SOUTH (G0202) INSTALL SIDEWALK GUY (GO107)
YPP qFr TPY STRIP, TOP & ABANDON POLE TO COMMUNICATIONS
INSTALL 8'ST LT ARM (L0503)
XFR ST LT HEAD SL-128364-A
INSTALL 3" RISER & SEC PED OU705)
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