5233131 EDMS PERMIT..pdfov wxlo +
ROW PERMIT NO.: ENG
ISSUE DATE:
'kL=V RIGHT-OF-WAY CONSTRUCTION
/'Vc. I S'�') PERMIT APPLICATION
PROJECT NAME: EDM'S ART INSTITUTE CONTACT: DOW BRANDLEY
CONTRACTOR: PACIFIC CABLE FOR FRONTIER Phone #: 425-263-5101
Mailing Address: 11321 HWY 99, EVERETT Fax #:
StateLicense#: 600-587-702 Email #: DOW. BPMDLEY@FTR. COM
City Business License #: _�Liability Insurance F1 Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 202 MAIN ST.
I ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
0 Commercial E:1 Subdivision El City Project LJ Traffic Control (Only)
Multi -Family E:1 Single Family Other
EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? 0 Yes ED No
I AW ASSOCIATED PERMITS? I I BLD# ENG# _771
DESCRIPTION OF PROPOSED WORK (Be Specific) : FRONTIER TO RELOCATE AERIAL FACILITIES
OVER TO NEW JOINT OWNED POLE WITH THE PUD FOR THE NEW EDMONDS ART 3UILDING.
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES R NO 0- Year:
PAVEMENT CUT: E] Yes F-1 No If yes, indicate size of cut: x
CONCRETE CUT: E] Yes F� No If yes, indicate size of cut: _x
RIGHT-O&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
I X
I 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 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
fo I low all requiremenm in o7rd r
SIGNATURE /-L?'
iderstand the permit requirements and acknowledge that I must
Z\ DATE 7-
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE