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ENG20140433.PDFIIII I I , - CITY OF EDMONDS ;, 121 5TH A VENUE NORTH - EDMONDS, WA 98020 I R9� PHONE: (425) 771-0220 - FAX: (425) 771-0221 Ifni *PERMIT MUST BE POSTED ON JOBSITE* STATUS: ISSUED ENG20140433 Permit Number: ENG20140433 Expiration Date: 02/13/2015 Job Address: 15500 75TH PL W, EDMONDS Location: 75th Pl W. COMCAST OF WA, LLC PACIFIC CABLE 1525 75TH AVE SW 11321 HWY 99 S410 Attn: Mark Welpman EVERETT, WA 98203 Woodinville, WA 98072 (425) 485-1515 LICENSE 4: PACIFCC954PJ EXP: 10/18/2015 Installing news ery ice drop for resident at given address. 62 ft of work is planned for the ROW; 16 ft of which are for a road bore needed to cross 75th Pl. W. See attachment for details. DISRUPTION INFORiMATION ASSESSED VALUE: $0.00 PROPERTY AREA: 0 SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0.00 STREET DISRUPTION TRENCH CUT: ( 0 X 0 ) PARKING: ( OXO) DURATION IN MONTHS: 0 FEE: $0.00 YEAR OF OVERLAY: 0 FEE: $0.00 ALLEY: ( OXO) DURATION IN MONTHS: 0 FEE: MOO [ADEAIATTY.• 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 of Edmonds or any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and attorney fees by reason ofgranting this permit. 7HECON7RACTOR IS RESPONSIBLEFOR WORKMANSHIP AND MATERIALS FORA PERIOD OFONEYEAR FOLLOWING 7HEFINAL INSPECTION AND ACCEPTANCEOFTHEWORK. • 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 ofthe required training in their possesion. • 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 per►nit application. CALL DIAL -A-DIG (1-800424-5555) BEFORE ANY EXCAVATION CALL FOR INSPECTION (425) 771-0220 EXT.1326 24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REQUESTS MISAPPLICATION IS NOT PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN SPACE PROVIDED. Printed: Wednesday. Aueust 13.20 SED BY FILE COPY INSPECTOR COPY DAPPLICANT COPY STATUS: ISSUED ENG20140433 • Restore ROW to City standards • Restore Landscape to like or better conditions. • Call for locates of underground utilities prior to any excavation. • Alert affected residents and/or businesses prior to work start. • Conform to approved working drawings and Traffic Control plan. • Public utilities maintain 5'separation from City Utilities. • Verify clear bore crossings • 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. • Traffic Control per approved plan and MUTCD. Refer to City of Edmonds traffic control requirements. • Three feet of clearance around fire hydrants, standpipes, P.I.V.'s, manholes, water meters, blowoffs, cleanouts and valves shall be maintained. • Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way per City standards that is caused by or occurs during the permitted project. • Sound/Noise originating fromtemporary construction sites as a result of construction activity are exempt fromthe noise limits of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on weekdays and 10:00am and 6:00pm on Saturdays, excluding Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must comply with the noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120. • Applicant, on behalf of his 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 fromthe issuance of this permit. 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. • ETraffic Control • E-Engineering Final PARTIAL INSPECTION DATE: INITIAL: NOTES: PARTIAL INSPECTION DATE: INITIAL: NOTES: FINAL INSPECTION APPROVED DATE: INITIAL: Of EDA,10 ROW PERMIT NO.: ENG V 3 ISSUE DATE: NQ EMP RIGHT-OF-WAY CONSTRUCTION rNc 390 PERMIT APPLICATION PROJECT NAME: COMCAST CONTACT: DARREN COLE CONTRACTO PACIFIC CABLE CONSTRUCTION Phone#: 425-485-1515 Mailing Address PO BOX 573 WOODINVILLE WA 98072 Fax #: 425-348-7966 State License #: PACI FCC954PJ Email #: DARREN@PACCAB.COM City Business License #: NR-019694 ❑X Liability Insurance ® Bonded ADDRESS OR INTERSECTION OF CONSTRUCTION: 15500 75TH PL W 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) : INSTALLING NEW SERVICE DROP FOR RESIDENT AT GIVEN ADDRESS. 62 FT OF WORK IS PLANNED FOR THE ROW; 16 FT OF WHICH ARE FOR A ROAD BORE NEEDED TO CROSS 75TH PL W. SEE ATTACHMENT FOR DETAILS. WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year: PAVEMENT CUT: ❑ Yes ❑X No If yes, indicate size of cut: X. CONCRETE CUT: ❑ Yes ® No If yes, indicate size of cut: X. RECEIVED JUL 31 2014 O_E-VELOFMENT SERVICES COUNTER 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 requir is in order for the permit to be valid. SIGNATURE DATE Contractor or Agent NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE 1AAIN'TA1N A KINIMW %0 1n119TH SA(-1k j> 1R% .-r100. :0 MA1 -MV4 AUEss To 'THE PA;LK 1%1 ALL -TtKS5. T025 SHCUtO �;`a, RROP9`F�/ �SHOUtDfR � �44`OR1(, ar W21-701 W21-5 (WSDOT) (WSDOT) SHOULDER WORK Applicant shall repair/replace all damage to Utilities or frontage improvements in City right-of-way per City standards that is caused or occurs during the permitted project. OWNERICOIV i RACTOR IS RESPONSIBLE FOR EROSION CONTROL AND DRAINAGE 4 N APPROVED AS NOTED BY EN INEERING Date: t 1 VA 7T#IZ9375 COMCOSt CSG Cocate#:'130�92— CSG Drop Buryll; Datel l- A/ Node:. Bury Drop i-orm Custorer Name: fil 1,41 Phone# ; 1-111 Address: 55 00 %Si� P W. City; 96- 64 Zi : � EW Cross Street: r� Servica Effectin ' out of Service ending install []Tamped Tech# : t,05 Tech Cell: Y25 7 `3 U6� Priority Level: 1-Commerclal st v ___ Im aired /Can't Tem 3 Svc Drop impaired / CanTemp TYps of Bury: STH Footage ROW Footage Permit Re wired: k and EasemcentYLINK Sidewelk8ore PlantingStri : Y ED N Xf Sprinkler System, Y Nly Drivewa Bore Sidewalk: Y N septic Field: Y N Landscape Bore Road Edge: Y NJ Draln Pipe: Y N Road Bare Curb: Y N Private Water. Y Nrg Soft surface Z Ward surface Total: Private Wiring: Y� N Total: 2 7oai: I Z ' I Total Bur : What Kind? Customer Home For Bury: Y N Cali Cuatoma First: Y N Best # For Customer: 4L Cammants Xle-o hoblig, �/ [ P+QN. IS r r L Fy ' -4 Zoto O o ' fA60 WP-rrAA ue r CUSTOMER CONTACTED AND REVIEWED ROUTING OF NEW DROP Y NOT HOME, LEFT DOOR TAG Being the owner of the above property, I herebygive my permission to.Comcast, orthelr duly authorized representative to bury a service line on my property, Property Owner's Signature: