ENG20150490-REVISED APPLICATION (2).pdfOV E VA,10
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PROJECT NAME: 109092829
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871 C2
City Business License #: NR -023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan. Sidick@a pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 7529 Braemar Rd
ROW WORD ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑X Single Family ❑ Other
❑ 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) : Replace 2" Dupont gas main in Braemar Dr from 76th Ave W to the end of the road at 7400.
install 1100' of 2" PE gas main from 23' East C/L of 76th, easterly on the north side of Braemar at approximately 21' north following the design of 109092829,
transition to the south side just past 7515 around the road at 7404 terminating at the Cul-de-sac. Replace the associated service per design 109092829
New permit and verbage
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES ❑ NO [:1 Year:109f;
PAVEMENT CUT: ® Yes ❑ No If yes, indicate size of cut: 3 x 5
CONCRETE CUT: 0 Yes F]No If yes, indicate size of cut: x_
RIGHT-OF-WAY DURATION
AREA TOTqSF
CLOSURE :(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF
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
Susan SIdICk .�'=�° b E-US-S'�".
Date: mts os ao os�ao nroo•
Contractor or Agent
DATE 4/25/2017
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Date of Request: 04/24/17
Job number: 109092829
Job address: 7529 Braemar Drive City: Edmonds Zip: 98026
Project mgr:
PM email:
John Guay
John.Guay@pse.com
Estimated job start date:
Estimated job completion date:
Description of work to be performed:
05/10/17
06/20/17
PM contact #: (425) 505-3768
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Install 11 of gas main fromof . on • •- of
Braemar at ,•• •ximately 21' north following the design of 1.1• : • transition to the
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A. -
Pavement
.
Pavement cut?es ®No
If yes, Dimensions of Cut: Length 3' Width 5'
How many cuts? 34 +/-
Surface Type asphalt
Require trenching? es F-71No
If yes, Dimensions of trench: Length Width Depth
Method of installation: Proposed - Hog / directional drill.
Traffic impact:
Road closed Elyes ®✓ No
Lane closed Eyes FNO How Many? Direction? west
Shoulder closed Yes F1 No
Sidewalk closed Myes FNo
Emergency Contact:_
Cell Number: