5220049 PERMIT.PDFOV ED&10 4/'
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
I'vc. I S9 PERMIT APPLICATION
PROJECT NAME. POLE RELOCATIO14
CONTRACTOR: PACIFIC CABLE
Mailing Address: 11321 HWY 99 S#10, EVERETT
State License #: 600-587-702
City Business License #:
CONTACT: DOW BRANDLEY
Phone#: 425-263-5101
Fax #:
Email N: DOW.BRANDLEY@FTR.COM
[I Liability Insurance Ll Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION. 8632-104TH ST SW
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
H Commercial 0- Subdivision 0 City Project [3 Traffic Control (Only)
M Multi -Family El Single Family n Other
[_1 EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? F1 Yes 50 N o
I ANY ASSOCIATED PERMITS? I BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific): FRONTIER AND PUD TO RELOCATE A VOLE FOR
A NEW SHORT PLAT.
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES [71 NOE]-Year: _�
PAVEMENT CUT: []Yes R No If yes, indicate size of cut: X
CONCRETE CUT: EJ Yes Fx� No If yes, indicate size of cut: _X
RIGHT-OF-WAY
DURATION
E
AREA
TOTAL
CLOSURE
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF
X
LF
SF
I
jA
N/A
Alley 72 Hrs + LF
X
LF
SF
N/A
Parking 72 Hrs + LF
X
LF
SF
N/A
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
. er or
follow all requirement ' old fl th r t t b fid.
SIGNATURE /(17aj DATE 7—
Contractor or Agent 0
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE