BLD20160404.pdfRECEIVED
ROW PERMIT NO.: ENGao ((,r '- o 4
ISSUE DATE:
ON %ta ro WEN KE -11",
PROJECT NAME: 100010458 Everett Cline
CONTRACTOR: Diversified Northwest Inc.
Mailing Address: PO Box 616 Lynnwood, WA
State License #: DIVERNI032D5
City Business License #: NR -021629
CONTACT: Jayson Gregory/Josh Ervin
Phone #: 253-682-9223/425-308-7280
I
Email #: jagregory/jervin@wavebroadband.com
X Liability Insurance X Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 216th St SW and 72nd Ave W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
E] Commercial E] —Subdivision El City Project Traffic Control (Only)
❑ Multi -Family El Single Family ❑ Other
X EUC (PUD, VE ION, PSE, ?()16
CO CAST, OVWSD):
-
Is this permit part of a blanket permit? El Yes X No !v
L��,�SSOCIAATED PERMITS9 BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific):
Directional bore approx 725' lay (1) 2' conduit south of 216th St SW and west of 72th Ave W.
Set (2) 24"x36" vaults and pull fiber optic cable. See plans for details.
SAMIUM 3 191J2210 MM NIA1311 Oil Igo 11131 U WIN-09LIAMMM, I �N
[!AVEMENT CUT: El Yes Mo If yes, i dicate size of cut: x
CONCRETE CUT: 0 Yes No If yes, indicate size of cut: x
RIGHT-OF-WAY DURATION
CLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Firs +
Alley 72 Hrs +
Parking 72 Hrs +
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
follow all requireme Ahe4)ermit to be valid.
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