ENG0170086.pdft�s I� t� 4�
%if jl% CITYOF
121 5TH AVENUE NORTH - EDMONDS, WA 98020
tr, PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBS TE*
STATUS: ISSUED ENG20170086
Permit Number:'ENG20170086 Expiration Date: 09/18/2017
Job Address: 23920 104TH AVE W, EDMONDS Location: 23920 104TH AVE W
CONTRACTORAPPLICANT
SNOHOMISH COUNTY PUD SNOHOMISH COUNTY FUD
P.O. BOX 1107 P,O, BOX 1 I07
EVERETT, WA 98206 EVERETT, WA 98206
(425);670-3216
LICENSE #: UBL313 005.741 EXP°
L JOB DESCRIPTION
Intercept existing underground power and route into new plat.
DISRtJPTION INFORMATION
ASSESSED VALUE. $0;,00 PROPERTY AREAE; 0'
SIDEWALK: ( OXO) DURATION IN MONTHS: 0 FEE $0,00STREET DISRUPTION TRENCH CUT: ( 0 X 0')
PARKING: ( 0X0')' DURATION' IN MONTHS: 0 FEE: $0„00 YEAR OF OVERLAY: 0 FEE $0,00
ALLEY° ( 0X0 DURATION IN MONTHS: 0 FEE: $0;00
INDEMNITY The Applicant has signed an application which states he/she holds the City of Edmonds harmless from injuries,
damages or claims ofany`kind or description whatsoever, foreseen or unforeseen, that may be made against the City ofEdmonds'or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
atiorneyfees by reason ofgranling this permit.
THE CONTRACTOR IS RESPO NS IBLE FO R WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCEOFTHEWORK
0 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
posseson:
Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or. City approved
material` prior to the end of the workday -NO EXCEPTIONS.
Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAL -A-DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICEREOUIRED FOR ALL INSPECTION REQUESTS;
S APPLICATION IS NOTA PERMITUNTIL SIGNED BY THE CITY IiN;i1Nh1°%1t; OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED,
Printed: rridy March 17, 201
RELEASED BY DATE
El FILECOPY INSPECTOR COPY F-1 APPLICANT COPY
STATUS: ISSUED
70086
w Restore ROW to City standards
0;'. Restore Landscape to like or better conditions.
0 Call for locates of underground utilities prior to: any. excavation.
0 Alert affected residents and/or businesses': prior to work start.
Conform to approved working drawings and Traffic Control plan.
0 Verify clear bore crossings
0 Utility patch restoration to be in accordance with Edmonds Standard: detail E2.3
.; Maintain erosion &` sedimentation ;control. Keep street clean.
Call for required inspections as noted.
0 Traffic Control per approved plan and MUTCD. Refer to City of Edmonds traffic, control requirements.
0 Applicant shall repair/replace all damage to utilities or fi•ontage improvements in City right-of-way per City standards that, is
caused by or occurs during the permitted project.
• Sound/Noise originating from temporary construction sites as a result of construction activity are exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on weekdays and 10:00amand 6:00pm on Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originating from constructionsites /activities must comply with the
noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
* Applicant, onbehalf ofhis or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
harmless the City of Edmonds, Washington, its officials,; employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance of this pemuit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance not limit in any way the City's ability to enforce any ordinance
provision.
INS PEC-FIONS
•. E -Engineering Final
PARTIAL INSPECTION DATE: INITIAL:NOTES:
PARTIAL INSPECTION DATE: INITIAL NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:��
of EVAst)
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME I IOOP WA l LciU K j
CONTRACTOR. .S�yUlt�iH �Sl� 6uu1j-ry PVD
Mailing Address: ............ __
State License #:
City Business License #:
CONTACT:
ONn! WLu/vN1 S
Phone #:
yZs — 793 — Y 76e,
Fax #: yZS— `7g2 —g1170
Email #: 3~L4/A1\.S C �nlo Pu h , C_c)r41
Liabili ............Insa. ww..................._...........
..
❑ ty rance ❑r Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: Z 3 � 0 10-v ria Ayc VV rpmN t,,S ri Pj a G
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE_ OF PROJECT:
1:1 Commercial Subdivision r City Project Traffic Control (Only)
❑ Multi -Family ❑ Single Family
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
❑ Other
❑ Yes ❑ No
IANY
ASSOCIATED PERMITS?
BLD#,_... EN G#
DESCRIPTION OF PROPOSED WORK (Be Specific) : I N 7EZCCEP-r E X/S7'0n/(,
UNoLfRci2ounlp-ocdElZ ASID ��uTE Ih(Tv /fEv�J PLJa7
WITHIN THE LAST FIVE (5) YEARS Y..���. ._..___.
..... .... � , � ES NO Yeas
WAS STREET OVERLAYED �mm_ .. _ _......._.
PAVEMENT CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
CONCRETE CUT: 0 Yes ❑ No If yes, indicate size of cut: x
RIGHT-OF-WAY DURATION
FLF
REA TOTAL
CLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Hrs + X LF 1 SF
......... µ.. Alley..72 Hrs +X LF SF
Parking 72Ht s + 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 acknowledge that I must
follow all requirements in .r for the permit o be val id.,
SIGNATURE ® DATE ..
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
LANE CLOSURE ON A TWO-LANE ROAD
(TWO FLAGGER OPERATION)
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TRAFFIC CONTROL PLAN
PROJECT �WQNQWAY COURT ...... - -----------
LOCATION 23900 104TH AVE W.EDMONDS 98020
.. ........... .
ENGINEER JOHN WILLIAMS DATE: 3/2/16 ORDER 396429
PHONE (425) 783-4766
CELLULAR (425) 346-6660
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