ENG0170196-APPLICATION.pdfOV ED&IC)4�
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ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 106324670
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871C2
City Business License #: N R-023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
F-1 Liability Insurance E:1 Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 1040 Glen St
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F] Commercial 0 Subdivision E] City Project El Traffic Control (Only)
F-1 Multi -Family X Single Family F1 Other
F-1 EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? F] Yes W No
I ANY ASSOCIATED PERMITS? I BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific): Work area is approx 19'N C/l of Geln St & 233'W c/l of Olympic Ave
1 3x5 soft surface cut also 12'S c/l of Glen St & 233'W C/1 of Olympic Ave 1 2x4 asphalt cut anticipated
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES 0 NOE] Year: 106b
PAVEMENT CUT: X Yes F-1 No If yes, indicate size of cut: -2 x4
CONCRETE CUT: E] Yes F-1 No If yes, indicate size of cut: X_
RIGHT-OF-WAY DURATION
CLOSURE AREA TOTAL (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF SF
Alley 72 Hrs + LFLXJLF SFParking 72 Hrs + 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 order for the permit to be valid.
SIGNATURE Susan Sidick X95 -°e-, Ws `5tr�`°� DATE 5/19/2017
Date: 2016 09 30 0]:5 ]30 -0T
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Job #:
Date:
Jurisdiction:
Right of Way Permit?
Est. Start Date:
F -,t nxmqxon-
206324670
5/1O/17
Edmonds
,so [] NO
O7/U3/i7
Address: 1O4OGLEN ST
City /Zip: ED/WOW0S98O2U
Customer: DENI5EO'BAZEN 206-718-3653
Construction Method
WORK DESCRIPTION:
Trenchless
WC 0/1Q.
PLAT MAP: 162 067
GLEN ST
5686-1963
CL
_CL
SIDEWALK
G
0
PL PL
LARGE ROCKERY
LU
WATER METER BOX
SEWER MANHOLE
FIRE HYDRANT (204'E FROM TIE IN)
Work Location
Size of Cut
Surface Type
3X5
GLF_N %T
SOFT SURFACE
ASPHALT
U-0-M—If—ILL
FLAGGERS # MPH TROLLY LINES BUS STCIP#
METER HOODS #
OFFICERS # SPEED LIMIT TRAFFIC SIGNAL E] ARTERIAL
NO PARKS #
commercial n Altered Commercial E] Leak Repair Service Information
E] Template Bar
Residential n Altered Residential F] CP Work Diameter Meter EFV
[:] Bollards 2.5" #
Multi -Family Ej Replacement Service Ej Pothole 0 5/8" F] 250 []
1800 E] Bollards 4" #
New Constr. n Main Maintenance E] Extension [0 11/8" E] 425 2]
2600
Stub El service maintenance [:] 11/4" F] 630
10,000 n FUEL LINE PERMIT NEEDED
Extension Valve Maintenance E] 2" El 1000
Fuel Line Length:
compete sery Cut & Cap Mtr Loc: O/R
Fuel Line Diameter:
I
/
4113 1040
CHANNELIZATION
DEVICE SPACING
MPHTAPER TANGENT
ssno 40
80
35145 30 1 60
25130 20 40
maintain (2) it' lanes ----
PtJGET
SOUND
ENERGY
Job#106324670
1040 Glen ST, Edmonds WA
May 16, 2017
Sheet 1 of 2 ryan.honeysett@pse.com
(425) 457-5381
Notes:
1. All signs and spacing to conform to the MUTCD
and City of Edmonds standards.
2. All sidewalks, driveways, exits and egresses shall be
completely clear unless otherwise indicated.
3. Channelizing devices are 28" traffic cones.
4. Sign size can be a minimum of 48" x 48" and shall not
obstruct pedestrian access.
5. Crew is required to leave a minimum of i i' for traveling
lane width.
6. Alert affected residents and businesses.
7. Work to take place between 9 a.m. and 4 p.m.
8. Work area vnll be 233' WCL of Olympic Ave
& 19' NCL of Glen ST.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
LEGEND
® Ta' TRAFFIC CONE
80RE PIT
TRAFFICFLOW
1'.'ORK VEHICLE
SIGN LOCATION
WARNING FLAG
W21-5aR
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
5sno 40 80
35/46 30 60
25/30 1 20 1 40
PUGET
SOUND
ENERGY
Job#106324670
1040 Glen ST, Edmonds WA
May 16, 2017
Sheet2 oft ryan.honeysett@pse.com
(425) 457-5381
Notes:
1. All signs and spacing to conform to the MUTCD
and City of Edmonds standards.
2. All sidewalks, driveways, exits and egresses shall be
completely clear unless otherwise indicated.
3. Channelizing devices are 28" traffic cones.
4. Sign size can be a minimum of 48" x 48" and shall not
obstruct pedestrian access.
5. Crew is required to leave a minimum of 11' fortraveling
lane Width.
6. Alert affected residents and businesses.
7. Work to take place between 9 a.m. and 4 p.m.
8. Work area Will be 233' WCL of Olympic Ave
& 12' SCL of Glen ST.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
LEGEND
® 28'TRAFFIC CONE
BORE PIT
r�7 TRAFFIC FLOW
WORK VEHICLE
SIGN LOCATION
�> WARIIIIIG FLAG
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