5231131 SIGNED PERMIT.PDFof 10,tlo
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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: REPLACE 45' POLE,
CONTRACTOR: PACIFIC CABLE FOR FRONTIER
Mailing Address: 11321 HWY 99, EVERETT
State License #: roo-.58.7-702
City Business License #:
ADDRESS OR INTERSECTION OF CONSTRUCTION:
CONTACT: DOW SRANDLEY
Phone #: 425-263-5101
Fax #:
Email #: DOW-BRANDLEY@FTR.COM
LJ Liability Insurance LJ Bonded
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Co—mmercial 0 Subdivision L1 City Project Tra—ffic Control (Only)
Multi -Family EO Single Family F-1 Other
[:1 EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit pan of a blanket permit? Yes [Id No
I ANY ASSOCIATED PERMITS9 BLD# ENG# I
DESCRIPTION OF PROPOSED WORK (Be Specific): REMOVE OLD JOINT PCLE AT 21420-96TH AV W
FTR PROJECT NUMBER 5231131.
WORKING WITH PUD TO REPLACE OLD POLE. PUD WORK ORDER 100027508.
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES M NO 1_J Year: �]
PAVEMENT CUT: [0 Yes No If yes, indicate size Of Cut: 3 x 3'
CONCRETE CUT: El Yes No If yes, indicate size of cut: _x
RIGHT-OF-WAY AREA TOTAL DURATION
CLOSURE I (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LIFF SF1 IS)
Alley 72 Hrs + LF X LF SF
Parking 72 Hrs + LF I X LF] ES F] HE]
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 I andgderstand
follow all requiremen in orde C-r t t
/ 1(f
SIGNATURE 7 "n"er" 0
Contractor or Agent
and acknowledge that I must
DATE
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE