City of Edmonds Permit App - AT&T Edmonds Ridge (2).pdfwog` tuUoaq� �-I 1p
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
."VC. ' SS 11 PERMIT APPLRCCATION
PROJECT NAME: C- Am a AA, Q, AAg' - �►� la3
CONTRACTOR: mo nom".'h vvvr u
Mailing Address: `J " %5 o x u rt
v ¢r C. it , W R 1K d•0 to
State License #:
City Business License #:
CONTACT: 1A c,0
Phone #:
Fax #:
Email#: So,�tu� a�noh.
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: ( � I, ('r> 5�rr_�_t / EA^^�nAS, ct�p 10
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,
CAST, OVWSD):
Is this permit part of a blanket permit? Yes ❑ No
ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : M o okA F'h -kLC, M-0,7
\4-rk r9to," A
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year:
PAVEMENT CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
RIGHT-OF-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
X
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 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 aelmowledge that I must
follow all requirements in order fyr- he pe , it - &A-Ard.
SIGNATURE �'� d DATE 54 S i t t
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
NTT 1EkN,)na, ►z a,3c_ , stJ's`S
CONSTRUCTION OPERATIONS AND ENGINEERING REQUEST
1818 Rev.11/98
TO FROM DATE
KEITH ELLISON AZIZ HAQ 425-783-5251 5/15/18
ADDRESS/LOCATION/POLE NUMBER
9126 MAIN STREET, EDMONDS 98020 // 19(27-4)SW // PL1: 264884
MAP NO. WORK ORDER NO. TASK NO.
454—H5 100029746 30
PLEASE ASSIST AT&T WITH THE MODIFICATION OF THEIR CELL —SITE
MODIFICATION INCLUDES REPLACING ANTENNA'S AND OTHER POLE —MOUNTED EQUIPMENT
POLE HEIGHT: 50' AGL
2
56
2 0 7TH
FL
C-1907
15 114
118
1
8
9114
9114 7 /10
N
64884
121384
MAINST ewa
0 m
PERRINVILLE-BALLINGER (116)
33sanc
272955
L-B 219
SL-114714-G8
679965
-8083
-114727-G
72953 p
SW 0
L-B 21
080'
'J fZ 9118
2
For de -energizing customer service for Customer work
Customer Signature
lribulion:
Date
9122
N f�
rn
1 0
or
0820
CREW HOURS
When completed, call
the PUD at 425-783-1000
or (1-877-783-1000) ask
for Energy Control Dispatch
> COMPLETED BY DATE
-Deportmen Responsible For Work -Return To Originator When Completed Blue -CIS, 03, After Work Completion
y-Deportment Responsible For Work -Fie Copy Pink -Originator
BUFFER DATA
TYPICAL PROTECTIVE VEHICLE WITH TMA (SEE NOTE 1)
VEHICLE TYPE
LOADED WEIGHT
4 YARD DUMP TRUCK,
MINIMUM WEIGHT 15,000 LBS.
SERVICE TRUCK,
(MAXIMUM WEIGHT SHALL BE
IN ACCORDANCE WITH MANU-
FLAT BED, ETC.
FACTURER RECOMMENDATION)
OROLL AHEAD STOPPING DISTANCE = 30 FEET MIN.
(DRY PAVEMENT ASSUMED)
LONGITUDINAL BUFFER SPACE = B
POSTED SPEED (MPH)
25
30
35
40
45
1 50
65
1 60
1 65
LENGTH B (FEET)
155
200
250
305
360
1 425
495
570
1 645
Lu
Z
i
Q
i
1'T
r
i
i
i
24" x 36" B/W
SIDEWALK
CLOSED
AHEAD
SIGN SPACING = X (1)
RURAL HIGHWAYS 60 ! 65 MPH
RURAL ROADS 45 ! 55 MPH
8OU ±
500' ±
RURAL ROADS & URBAN ARTERIALS 35 ! 40 MPH
350' ±
RURAL ROADS, URBAN ARTERIALS, 25 ! 30 MPH
RESIDENTIAL & BUSINESS DISTRICTS
200' ± (2)
URBAN STREETS 25 MPH OR LESS
100' ± (2)
ALL SIGNS ARE BLACK ON ORANGE UNLESS DESIGNATED OTHERWISE
Main St
LEGEND TRAFFIC CONTROL PLAN
® WORK LOCATION EDMONDS, WA
❑ ❑ ❑ ❑ ❑ CHANNELIZATION DEVICE n '
N SIGN LOCATION
�— EXISTING TRAFFIC FLOW V
e� FLAGGER I I I SCCALEC
M
0- — Ls
5 3
36" x 24" BAN cD !v �'
SIDEWALK 36" x 24" B/W E3 x
CLOSED SIDEWALK
CLOSED �
R I R5-8_ 1�
ROAD
WORK
AHEAD
24" x 36" B/W
SIOELYALK
ClOSEO
AHEAD
Parking Lane °
0 e�
�- °❑El%WORI(AREA ❑°❑❑
— — — — -- — — — — — — — — — — — — — — — — — — — — — — — — — — — —— — — — — — -
-All. %_j
Addtl. Notes:
N
N
ROAD NE LAN
WORK ROAD
AHEAD AHEAD
Advance Warning signs
spaced @ (X) or as space
allows.
See sign spacing chart above
H
50'min.
to
300' max
Shall maintain 11'
min. lane width
During hours of darkness, FLAGGER stations shall be
illuminated Without causing glare to the traveling public
by using a portable light tower or approved alternative.
(WAC 296-155-305)
-1--3
0
0
CD
c:1-
ca
28" Refl. Traffic Cone
Traffic Control Supervisor
Hrergieen Safety Council
Card # 006782
Traffic Plan Designer
jao od Cao penter
i
Exo.Date Co. LLC
12/31/15
i
• NE LAN ROAD
■� AD WORK
AHOEAD AHEAD
H F-► I-P
SNQI`IQMIS1•I CC3EJNTY
PUpLIC UTILITY pi$TRICF NO, 7