eng20130014-ROW application.pdf.-, oE-VA�lf-).
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ROW PERMIT NO.: ENGlil
ISSUE DATE: �1 � Z,"I,
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PROJECT NAME: 4$d,,�,AUq, CONTACT: Ye v , ,� (NjeV,,�
CONTRACTOR: V),U&Phone #:
Mailing Address: Fax #:
State License #: WC). -2_2_2_ _ 2_9�1 Email
City Business License 9: Liability Insurance Bonded
0-12-0 (e)&V\ _K�,A�t F6 rncJy1d,)
Commercial I I Subdivision
F-1 Multi -Family 9 Single Family
F] EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
� ANY ASSOCIATED PERMITS? �
117011] WIN 91,121511.
City Project
F-1 Other
F-1 Yes M No Job Number
BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific):
FUMNAUTINLIK
El Yes El No
El Yes M No
Traffic Control (Only)
If yes, indicate size of cut: x
If yes, indicate size of cut: __x
RIGHT-OF-WAY DURATION
AREA TOTAL
CLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF SF
Alley 72 Hrs + LF X JLF SF
Parking 72 Hrs + LF X SF
APPLICANT1 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.
INDEMITY• 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 ofrg anting this permit.
I have read the above tatements a d understand the permit requirements and acknowledge that I must
follow all re( is in order f' the permit to valid.
SIGNATURE DATE 7 y
Contractor or Agent