City of Edmonds Permit - 100025682 (2).pdfAiv&—
. 1 8-90
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: S(4'Fef Cke.fLr16"Xnc..4_rss,�t,
CONTRACTOR: 1
jj j�
Y'0�oen.1h CJ -il S"�b
Mailing Address:
Pd,13Qx Ir�U��
State License #: t77
City Business License #:
CONTACT: %
Phone #:
)ej -Sf S'q
Fax #:
Email #: ia+wG'r p Ad , t:.-
❑ Liability Insurance ❑ (Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 4� Ll 'T;J� L""'"_ no"IJ
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project Traffic Control (Only)
❑ Multi -Family ❑ Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this perinit part of a blanket permit? ❑ Yes ❑ No
ANY ASSOCIATED PERMITS? BLD# ENG#.
DESCRIPTION OF PROPOSED WORK (Be Specific): Qzp,acQ ��-�SdL t�uz "�L
c�rs�.k Af3lC Sl:d na (Itt� ,�� at✓1 Cf'� i�2W c1 !`bLA (Af- rt.,C�
io��'t`tia ISfI.�� utJ�9 I fa't7�� YMCA1lE�r+�rr°^, �i/J,�C C-i�`� ��•2,
i1
5 i n to `` Y''k o , , .} c
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES ❑ NO ❑ Year:
PAVEMENT CUT: ❑ Yes ❑ No If yes, indicate size of cut:
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut:
x
x
RIGHT-OF-WAY
CLOSURE AREA
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF
X
LF
SF
n
{W�►
Alley 72 Hrs + LF
X
LF
SF
Parking 72 Hrs + LF
X
LFJ
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 {WAQ 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 understand the permit requirements and acknowledge that I must
follow all requirements in ord for the emit to be valid.
SIGNATURE1--/�Y DATE 1 ZA E
Contractor or Agent '
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
= PUBLIC UTILITY DISTRICT NO.1 OF SNOHOMISH COUNTY 100025682 REPLACE
LOCATION -
OCATION_. 8229 T ALB O T_-_ R D.,.__E D-M O N D S__._._. _. _. _. _._.._.._. _.._.._......_......._.___L Y N N_W O O D AREA
POLE NO. LI ' ................. - - /4S..._ ... -T '� ....R - DATE ..__....__ !` Jl'' 9 ..._.__.. ORDER 10002:_ 68
REASON FOR WORK..M D- f-(� A ��1 ) i R. ENGINEER MRLAUER OPERATION 00_30.----.._..
,I•AL TRD._� _ _ _ _ DRAFTER lti'RL U.G. N0. N/A
SCALE N"I s
APPROVED
& DATE PRINTED
DATE WORK COMPLETED _ DATE__--f�='
FOREMAN.-------. SUBSTATION PRV _
FEES R E Q' D ❑ YES 1 NO CIRCUIT NO. 2-PHASE _ 21 _-__
PRIMARY OVERHEAD
RESIDENTIAL
COMMERCIAL
L NO.
SE NDARY OVERHEAD NESC VIOLATIONS
BASIC FEE f_ ❑ NO IA YES (SEE NOTES)
'@$ =$ PERMITS (DATE GRANTED)
METER CONV_ POLE g ■ TREE TRIM
PRIMAR UNDERGROUND ^ ❑ STATE --_---------__
L7 RESIDEN IAL ❑COUNTY __ _,_
❑ COMMERC L CITY --
BASIC FEE S ❑
LEU No. EASEMENTS
❑ REQUIRED ■ NOT REQUIRED
SECONDARY
UNDERGROUN
D
NDERGROUND----------------- ----
ASIC FEE S
$ _$ DATE RELEASED
LAT FOREIGN CONTACTS
BA C FEE 8 ■ JPN# _1025...._......._...._.. _
❑JOINT TRENCH FRONTIER & CATV
FTA$ '_
STREET LIGHTING T_ � -❑ JotNT BORE FRONTIER & cATv
STREET LIGHT:ING(i FT.@t '=S
WORK IN RIGHT OF WAY POLE STENCILING
D PRIMARY FROM TO _
TAKE OFF POLE
❑ SECONDARY .............
_..._ - _—
q FT.@$ _' g PRE-CONST. REQUIRMENTS
MISCELLANEOUS FEES IN TREE TRIM ❑ PUD LOCATOR
VAULT 8 ❑ BACKHOE ■ FLAGGING
■ ONE CALL DATE
PERMIT i No. —u
s STREET LIGHTING
_ S _ 0 YES ❑ NO
M&R AS -BUILT
S GIS
TOTAL DUE S_ GIS OC M&R
DATE PAID _
RECEIPT NO. GIS Ph JOINT USE
SERVICE ORDER NO. �- LOCATION MAP PAGE 454 J1
LEGEND:
0 EXISTING POLE
S( EXISTING PULE -TO BE. REMOVED
• NEW POLE
)10 NEW POLE TO REPLACE EXISTING POLE
ENGR'S TEL. #
25— t83-515 -
ENGR'S CELL #
1425-239-0858
PLI 4502 - CLEARANCE SAFETY ISSUE
0 PL:.I 4 502'
PI,. D SERVICEMAN REPORTED MID -SPAN CLEARANCE SAFETY Y ISSUE OVER T'ALBO I RD
EXISTING NESC VIOLATION - FRONTIER & COMCAS I
MID- SWAN CLEARANCES BELOW 18' OVE,R ROAD
_ 40' P{ ILE-' TO BE REPLACED WITH 50' 112 (DUCTILE IRON POLE.
NEW POLE TO BE SET '!O' NW OF FOG LINE (APPGX 4' SE OF OLD PULE)
. POLE TO BE SET 11" DE
E:P (4' DEEPE.R THAN NORMAL)
IN A 4.' X 12' STEEL. 'C'U...VERT BACKFILLED W/ CRUSHED ROCK
�. POLE TO BE RAKED 4" TO SOUTHEAST
w.. POLE TO BE FRAMED W1 CU X0 551, T E I ERGLASS ALLEY ARM I" ACINr' NOR- TH WEST
- NEUTRAL. I' BELOW XARM
NOTES.
COMCAST TO TRANSFE:R AT 40G: BELOWNEUTRAL
FRONTIER TO TRANSFER AT 58 BELOW NEUTRAL
SHEET I OF
1
FTA$ '_
STREET LIGHTING T_ � -❑ JotNT BORE FRONTIER & cATv
STREET LIGHT:ING(i FT.@t '=S
WORK IN RIGHT OF WAY POLE STENCILING
D PRIMARY FROM TO _
TAKE OFF POLE
❑ SECONDARY .............
_..._ - _—
q FT.@$ _' g PRE-CONST. REQUIRMENTS
MISCELLANEOUS FEES IN TREE TRIM ❑ PUD LOCATOR
VAULT 8 ❑ BACKHOE ■ FLAGGING
■ ONE CALL DATE
PERMIT i No. —u
s STREET LIGHTING
_ S _ 0 YES ❑ NO
M&R AS -BUILT
S GIS
TOTAL DUE S_ GIS OC M&R
DATE PAID _
RECEIPT NO. GIS Ph JOINT USE
SERVICE ORDER NO. �- LOCATION MAP PAGE 454 J1
LEGEND:
0 EXISTING POLE
S( EXISTING PULE -TO BE. REMOVED
• NEW POLE
)10 NEW POLE TO REPLACE EXISTING POLE
ENGR'S TEL. #
25— t83-515 -
ENGR'S CELL #
1425-239-0858
PLI 4502 - CLEARANCE SAFETY ISSUE
0 PL:.I 4 502'
PI,. D SERVICEMAN REPORTED MID -SPAN CLEARANCE SAFETY Y ISSUE OVER T'ALBO I RD
EXISTING NESC VIOLATION - FRONTIER & COMCAS I
MID- SWAN CLEARANCES BELOW 18' OVE,R ROAD
_ 40' P{ ILE-' TO BE REPLACED WITH 50' 112 (DUCTILE IRON POLE.
NEW POLE TO BE SET '!O' NW OF FOG LINE (APPGX 4' SE OF OLD PULE)
. POLE TO BE SET 11" DE
E:P (4' DEEPE.R THAN NORMAL)
IN A 4.' X 12' STEEL. 'C'U...VERT BACKFILLED W/ CRUSHED ROCK
�. POLE TO BE RAKED 4" TO SOUTHEAST
w.. POLE TO BE FRAMED W1 CU X0 551, T E I ERGLASS ALLEY ARM I" ACINr' NOR- TH WEST
- NEUTRAL. I' BELOW XARM
NOTES.
COMCAST TO TRANSFE:R AT 40G: BELOWNEUTRAL
FRONTIER TO TRANSFER AT 58 BELOW NEUTRAL
SHEET I OF
1
LEGEND:
0 EXISTING POLE
S( EXISTING PULE -TO BE. REMOVED
• NEW POLE
)10 NEW POLE TO REPLACE EXISTING POLE
ENGR'S TEL. #
25— t83-515 -
ENGR'S CELL #
1425-239-0858
PLI 4502 - CLEARANCE SAFETY ISSUE
0 PL:.I 4 502'
PI,. D SERVICEMAN REPORTED MID -SPAN CLEARANCE SAFETY Y ISSUE OVER T'ALBO I RD
EXISTING NESC VIOLATION - FRONTIER & COMCAS I
MID- SWAN CLEARANCES BELOW 18' OVE,R ROAD
_ 40' P{ ILE-' TO BE REPLACED WITH 50' 112 (DUCTILE IRON POLE.
NEW POLE TO BE SET '!O' NW OF FOG LINE (APPGX 4' SE OF OLD PULE)
. POLE TO BE SET 11" DE
E:P (4' DEEPE.R THAN NORMAL)
IN A 4.' X 12' STEEL. 'C'U...VERT BACKFILLED W/ CRUSHED ROCK
�. POLE TO BE RAKED 4" TO SOUTHEAST
w.. POLE TO BE FRAMED W1 CU X0 551, T E I ERGLASS ALLEY ARM I" ACINr' NOR- TH WEST
- NEUTRAL. I' BELOW XARM
NOTES.
COMCAST TO TRANSFE:R AT 40G: BELOWNEUTRAL
FRONTIER TO TRANSFER AT 58 BELOW NEUTRAL
SHEET I OF
1
LANE CLOSURE ON A -FWO----L-.ANE LOW----VOL-UME ROAD
(ONE' FlILAGGIER OPERATION)
W20-1 S I CA
--sp-EED SPACING BUFFER
LIMIT (F T)
W20-4.
25 1 200 505
30 200 85
W20-7A = 3 5 350 120
40 350 170
4 5 Soo 220
50 500 280
55 500 335
d)
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W20-7A w
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W.20-4 u-
•W20--1
- 0
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f SNOHOMISH COUNTY
E
TRAFFIC CONTROL PUkN
PUBLIC UTILITY DMrtdCT NO 17
PROJECT -REPLACE PLI 4502 CLEARNACE SAFETY ISSUE IaN
LOCATION 8229 TALBOT MEDMONDS 0
ENGINEER MICHAEL LAUER DATE 1/12/2018 ORDER 82 1000256L
ou
PHONE 425-783-5154 C"4
CELLULAR 425-239-0858 <
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