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-OCT 112013
DEVELOPMENT SERVICES
ROW PERMIT NO.: ENG Q - 0
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: Comcast JOB# 241056 CONTACT: Vicki Bums (Comcast)/Aindrea Justice(SEFNCO)
CONTRACTOR: SEFNCO Communications
Mailing Address: 12303 Cyrus Way Mukilteo, WA 98275
State License #: SEFNCI*994P9
City Business License #: NR-016074
Phone #: 425-263-5461/253-299-8582
Fax #:
Email #: Vi6ki_Bums2@cable.comeast.com
aiustice@SOnco.com
0 Liability Insurance ❑x Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 9104 OLYMPIC VIEW DR
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ ' Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑ Single Family ❑ Other
❑X EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes ❑ No
ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) :
1. ) From existing comcast facilities, bore/trench south approx 5' 2. ) then head east approx 80' in hard surface with
directional drill/bore 3. ) then turn and go north approx 5' with bore/trench 4. ) At edge of row and private property,
set new drop carson and continue to private property with 3/4" drop in duct to customer home at 9104 olympic view
dr. NOTES: ALL WORK IN ROW WILL BE TO PLACE 2" CONDUIT FOR REPLACEMENT OF SERVICE DROP
TO CUSTOMER. ALL ASPHALT WILL BE REPLACED TO AS IS OR BETTER CONDITION AND TO ALL CITY
STANDARDS.
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 acknowledge that I must
follow all requirements in order for the permit to be valid.
SIGNATURE Ai wdrea- J V44it e DATE 10/11 /13
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE