ENG20160160.PDF08
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OF E� OWN
CITY OF EDMONDS
121 5TH A VENUE NORTH - EDMONDS, WA 98020
o PHONE: (425) 771-0220 - FAX: (425) 771-0221
�c. 189
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20160160
RIGHT OF WAY PERMIT (6-EUQ
Permit Number: ENG20160160 Expiration Date: 11 /07/2016
Job Address: 23201 75TH PL W, EDMONDS Location: 23201 75th PL W - 4 Locations in total around
Edmonds
PSE/Infi-asource PSE/Infrasource
C/O Susan att: Sidick C/0 Susan art: Sidick
1660 Park Lane 1660 Park Lane
Burlington, WA 98233 Burlington, WA 98233
(425)457-6353
LICENSE 9: infrasl87lc2 EXP: 02/22/2017
I 1 1
Permiss ion requested to pothole multiple address 2320175 PI W, 23320 74 Ave W, 23614 86 Ave W, 23910 74 Ave W 3N5 paving cuts
anticipated on all potholes.
DISRUPTION1 1
ASSESSED VALUE: $0.00 PROPERTY AREA: 0
SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0.00 STREET DISRUPTION TRENCH CUT: ( 3 X 5 )
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 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.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OFONEYEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OFTHEWORIC
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 NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
THIS APPLICATION IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEEROR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Thursday. Mav 05.201
FILE COPY ❑ INSPECTOR COPY ❑ APPLICANT COPY
6
STATUS: ISSUED
ENG20160160
• 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.
• 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 7:00am 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 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.
• E-Engineering Final
PARTIAL INSPECTION
PARTIAL INSPECTION
FINAL INSPECTION APPROVED
INSPECTIONS
DATE: INITIAL: NOTES:
DATE: INITIAL: NOTES:
DATE: INITIAL:
Ov EVA,10
. - �O ROW PERMIT NO.: ENG O 1 1(�C�
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
'A'c.. I, s,�0 PERMIT APPLICATION
PROJECT NAME,: 874016103 CONTACT: Sue Sidick
CONTRACTOR: PSE/Infrasource
Phone #: 425-457-6353
Mailing Add.:ess: 1660 Park Lane, Burlington, WA 98233 Fax #:
Statc License #: INFRASL871 C2 £' Susan.Sidick@pse.com
City Business License#: NR-019840 ❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: Pothole Multiple Locations see attached drawiu
ROW WORT{ ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ � City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑ Single Family ❑X Other
❑ EUC (PUD, V.ERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes No
CONY ASSOC:IAT.ED E'ERMITS9 BLD# ENG#
DESCRIPT[ON OF .PROPOSED WORK (Be Specific) .: Permission requested to pothole multiple address
23201 75 PL W, 23320 74 AVE W, 23614 86 AVE W, 23910 74 Ave w
3x5 paving cuts anticipated on all potholes
WAS STREET OV.ERLAYED WITHIN T.HE LAST FIVE (5) YEARS? YES ❑ NO ❑ Year:8746
PAVEMENT CUT: ® Yes ❑ No If ,yes, indicate size of. cut: 3 x 5
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: x_
01
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 1 must
fol low all requirements in order for the permit to be valid.
SIGNATURE DATE �l
Contrac or or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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Location#
SAP Notification #
Plat
Project Address
TCP Packet
1
11100704
166.07
23201 75TH PL W, EDMONDS
SHEET 3
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11100705
166.07
23320 74TH AVE W, EDMONDS
SHEET 3
3
11103690
167.068
23614 86TH AVE W, EDMONDS
SHEET IT9
4
11103719
167.07
23910 74TH AVE W, EDMONDS
SHEET 3.
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