5223902-77 SIGNED PERMIT (2).pdfof ED.t,C)
ROW PERMIT NO.: ENG
ISSUE DATE:
" t I MM-" RIGHT—O&WAY CONSTRUCTION
,'�!C. 1 IWO 3 PERMIT APPLICATION
PROJECT NAME: CHARLENES COURT SHORT PLAT CONTACT: DOW 13PJUMLEY
CONTRACTOR: PACIFIC CABLE FOR FRONTIER Phone N: 425-263-5101
Mailing Address: 11321 HWY 99, EVERETT Fax #:
StateLicense#: 600-587-702 Email #: DOW.BRAUDLEY@FTR.COM
City Business License N: Liability Insurance [:] Bonded
8606-220th st sw
ADDRESS OR INTERSECTION OF CONSTRUCTION:
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F] Commercial Ej Subdivision [I City Project El Traffic Control (Only)
Multi -Family D Single Family F] Other
EUC (PUD, VERIZON, PSE,
CONICAST, OVWSD):
Is this permit part of a blanket permit? Yes No
I ANY ASSOCIATED PERMITS? � I BLD# ENG# I
DESCRIPTION OF PROPOSED WORK (Be Specific): AUGMENT FIBER CABLE FOR NEW PLAT.
FTR PROJECT NUMBER 5223902-77.
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES El NO [I Year: :1
PAVEMENT CUT: [I Yes KI No If yes, indicate size of cut: 3 x 30
CONCRETE CUT: El Yes El No If yes, indicate size of cut: _x_
RIGHT-OF-WAY
AREA
CLOSURE
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF
X
LF
SF
Alley 72 Hrs + LF
X
LF
SF
Parking 72 Hrs + LF
X
LF
SF
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 he/she 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 unde tand the
follow all requirementsi n rder fi r the lit to be
SIGNATURE �,�Om
Contractor or Agent
ep
requirements and acknowledge that I must
DATE Z2-
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE