C Ave rain garden ROW permit app ENG20160413.pdfROW PER M IT NO.: ENG MI
1'DATE:
.1 4,S" U V
PROJECT NAME:
. . . ......... . . ...................... . . . ....... ... .. .....
CONTRACTOR:
. . ........ . ....... -
Mailing Address:
. . . . . .... ....... - ....- State License #:
130A)(
City Business License
CO I NTACT: A/rd ...............
Phone 4: Ll) -5- L/I 7- 63 0,7
Fax #:
Email #
Liability Insurance 13tdled
ADDRESS OR INTERSECTION OF CONSTRUCTION: A'V e- P, M e 'U 'd
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
0
' Commercial iv........................ ision [] City Project E] Traffic Control (Only)
.................................... ... Subd.
F-1 Multi -Family Ej Single Family [Other
Fj EUC (PUD, VERIZON, PSE,
COMCAST _'OVWSD):
Is this permit part of a blanket permit? ❑ Yes El No
FANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROP0,St' I) NVORK (Be Specific): _ New P66
moor, MIM
WAS STREETOVERLAVED wfrim THE I.,AST14'IVE (5) VEARS. W9 [R"N__0 0- Ye'
PAVEMENT CUT: El Yes El No If yes, indicate size of cut: x'
CONCRETE CUT: n Yes 0 No If yes, indicate size of cut: X.
RIGHT-OF-WAY AREA TAL DURATION
CLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF SF
Alley 72 Hrs + LFX �F SF
Parking 72 Hrs + LF j X I / LF SF
v\r J Q&n i -el NeC'� n ne) l
APPLICANT TO READ AND SIGN
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*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 abov statements and understand the permit requirements and acknowledge that I must
follow all wtq n dc��i� permit to be valid.
t��r���t is i
SIGNAl`lJI E- F DATE �
Cont actor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
From: McConnell, Jeanie <Jeanie, cCoinnefl@,g'd!L
M
Sent: Thursday, September 8, 2016 2:21:57 PM
To: Dan Fine
Cc: Cawrse, Michael
Subject: RE: Fir St & C Ave Improvements (Dan Fine - 838 Fir Street)
Dan,
Ignt-or-way YCt[on �-Frfmt M n7ea F ul-L'J"'
the proposed plan and associated construction details. A traffic control plan will also be required. A
licensed and bonded contractor is required to sign the ROW permit application. in addition, an
encroachment permit shall be submitted to the City. Upon submittal of the required per
applications, the project will be assigned to City staff for review. We have a significant backlog of
reviews at the moment and while we will assign a 2 -week target date for the review, it could be
longer. ltjust depends on how many projects are in the queue when your project comes in. We will of
course get to your project as soon as possible after submittal, as we do with all projects.
Regards,
Jeanie
C'C' sri-vl-4-ctc; 0
co
TWF-J�-Z7