ENG20150111.PDFOp EDIV
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: 425 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20150111
RIGHT OF WAY PERMIT (6-EUC)
Permit Number: ENG20150111 Expiration Date: 10/09/2015
Job Address: 19106 OLYMPIC VIEW DR, Location:
EDMONDS
Infrasource Infrasource
GO Julie Sirrimons C/O Julie Simmons
13330 Stone Ave N 13330 Stone Ave N
Seattle, wa Seattle, wa
LICENSE #: NRO19840 EXP: 02/14/2013
JOB DESCRIPTION
One at a time occupying the N and S bound lanes of Olympic View Drive to install long -side scat
service w/425 meter to 19106 Olympic View Drive.
One 3' x 5' cut.
Pavement cut - Yes
WO # 106295376
DISRUPTION
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: $0.00
INDEMNITY.- The Applicant has signed an application which states he/she holds the City of Edmonds harmlessfrom 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.
THECONIRACTOR IS RESPONSIBLEFOR WORKMANSHIP AND MATERIALS FOR A PERIOD OFONEYEAR FOLLOWING THEFINAL
INSPECTION.AND ACCEPTANCE OF THE W O RK.
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
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 permit 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
THIS APPLICATION IS NOTA PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Thursday, April 09, 2015
y19 //-5-
E COPY INS PECTOR COPY D APPLICANT COPY
STATUS: ISSUED
ENG20150111
• 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.
• 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.
• 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 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:OOam to 6:OOpm on weekdays and 10:00am and 6:OOpm on Saturdays, excluding
Sundays and Federal Holidays. At all othertimes 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 from the 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.
INSPECTIONS
• ?-Traffic Control
• 11Engineering Final
PARTIAL INSPECTION DATE: INITIAL:
PARTIAL INSPECTION DATE: INITIAL:
FINAL INSPECTION APPROVED DATE: INITIAL:
NOTES:
NOTES:
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PLAT MAP:
Crry u-rIUTIES
ToYLP'l ..14 AiNS1.
MAnu
CcnCAIM 4AAMNI �cyMhlC-
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v. 5
Work Location
5 Size of Cut ; Surface Type
1Qd 'tSfCL. :CHERRY ST
r.:: .., :E ofCt 01"YMPIC VIEW DR".__....,.., !..._.. ASP---H LT
'N S of CL
T of CL _..
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[] FLAGGERS # 2. 25MPHr
TROLLY.LINES:
❑.:Sus STOP"
❑ 'METER HOODS #
:OFFICERS`#N SPEED LIMIT
❑ TRAFFIC SIGNAL.
❑ -ARTERIAL
Commercial Altered Commerclai
u Residential
L1 �' Altered
L] Leak.Repair
SerVlce Information
a Template Bar -�-- -
Residential
❑ Multi-FamilY Replacement Service
❑
CP,Work
❑ Pothole
p�amafer Meter
❑ 5/8 ❑, z50
EFV
❑ Bollards`2.§" # _
❑ 180t)
New Constr., ,❑; Main Maintenance
❑' Extension
48
2660 ❑ Wlards`4" #
Stub` ❑Service Maintenance
Extension Vaive'Maintenance
H
i1/411
2" 8
'630,
1000
d, 10;000 ( FUEL LINE AERMtI NEEOED
1-
' Compete sery
e Cut 8i Ca{a
Fuel;Lme'l eng#fi: --- -
PROJECT NAME: . .
I or, 29 5
CONTRACTOR:
Mailing Address:
13330 Sfy" ftre- A)
State License 9:
/A) fia,&rS (_.K �- I CZ_
City Business License 12
ROW PERMIT NO.: ENGaL')/-5" rfr
ISSUE, DATE:
CONTACT- 6M
Phone #:
2D6; 9q9_'59Y4
Fax 9:
Email #:
emihl' P_)e_S+-(L
Liability Ins'Jurance F1 Bonded
ADDRESS OR INITERSECTION OF CONSTRUCTION: q/
ROW WORK . ASSOCIATED WITH TFIE FOLLOWING TYPE OF PROJECT:__�
[_1 Commercial F-1 Subdivision ❑ City Project Traffic Control (Only)
❑ Multi -Family M Single Family D Other
EU'C (PUB, VERIZON, PSE, AMR 2 6
COMCAST, OVWSD):
Is this permit part of a blanket permit? F] Yes El No DIVISjON
ANY ASSOCIATED PERMITS? BLD# ENGA
DESCRIPTION OF PROPOSED WORK (Be Specif&M 04= in n,-r
(J
6),,,d i"s &r nqrApic. V,e_L,..1 1:5r sc,""4- bg5v"C4
J
!tt'4 42-; f�-��tr �-h 19106 014mP;1' Vit"o Dr. 1(3'), OULU C I
J
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES E] NO
PAVEMENT CUT: � Yes El No
CONCRETE CUT: F-1 Yes Y No
If yes, indicate size of cut: 3 X 51
If yes, indicate size of cut:
RIGHT-OF-WAY DURATION
AREA TOTAL
CLOSURE (NUMBER OF MONTHS)
Sidearalk 48 Hrs + LF X LF SF
Alley 72 Hrs + I LF X LF sk
Parking 72 Hrs + LF X LF SF
APPLICANT TO DEAD 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.
Indemnify: 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 DATE a1 ZLIAt S
Contractor or Agent
I
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE