ENG20160276.pdf0
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ROW PERMITNO.:
ISSUE DATE:
RIGUIT-OF-WAY 'ice ONIJP RUCTION
PERMIT APPLICATION
PROJECT NAME: 1,063`[23"37'--'-'/ CONTACT: Sue Sidick
J
CONTRACTOR: PSE/InfraSOUrce
Mailing Address: 1660 Park Lane, Burlington, WA 98233
Mate Licensefl- INFRASI-871102
City Business License 4: NFA -019840
P110" g: 425-457-6353
Fax #:
F-1 IEEE C
JUL 19 2016
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Email #: Susan. Sid ick@pse, corn
Aability Insurance El Bonded
ADDRESS OR TNTERsEcriON OF CONSTRUCTION: 933 Maple St
ROW WOR K ASSOC] ATED WITH THE FOL LOWING TYPE OF PROJECT:
0 Coninielreial F-1 Subdivision El City Project El Traffic Conti-ol (Only)
❑ Multi -Family [� Single Fairnily El Other
EJC" (PUD,VL�RIZON,PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit'? [:1 Yes L*
.1 No
ANY ASSOCIATED PERMITS? 13LDH ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific): Permission requested to install 1-1/8" PE
gas set -vice at approximately 310'W c/l of 10th AVE S & 24'N c/l of Maple Ave
1 3x5 out on grass
PAVF,MENT CUT: El Yes El No If Yes, indicate size of eut: ----X
CONCRETE CUT: El Yes El No If yes, indicate size of cut: X
APPLICANT TO READ AND SIGN
*Traffic control arul public safety shall be in accordance with City regulatioiis as required by the City
Engineer. Every flagger must be trained as required by (WAC) 296155-305 and must have certification
verifying completion of the requirecl tra.itiing in their possession.
'Restoration is to be in accordance with City codes and Stanclards, All street -cut trench work steal l 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 helshe 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 111ust
follow all requirernent:s in order for the permit to be valid.
F
07/18/2016
SIGNATURE DATE
Contractor or Agent
ISSI
NO WOIUC SMALL BEGIN PRIOR TO PERMIT ;ANCE
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55!10 40 80
35/45 30 GD
25/30 L 20 40
21e9-tzM
933 z0�o 'WIM We iolio
N. Z-9NJ b 4
ENGINEERING
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MAPLE ST
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Notes:
1. All signs and spacing to conform to the MUTCD
and City of Edmonds standards.
2. All sidewalks, driveways, exits and egresses shall be
completely clear unless otherwise indicated.
i
3. Channelizing devices are 28" traffic cones.
LEGEND
4. Sign size can be a minimum of 48" x 48" and shall not
22 122
28' TRAFFIC CONE
obstruct pedestrian access.
tM BORE PIT
5. Crew is required to leave a minimum of 11' for traveling
TRAFFIC FLOW
lane width.
8. Alert affected residents and businesses.
WORKVEHICLE
7. Work to take place between 9 a.m, and 4 p.m.
F► SIGN LOCATION
8. Work area will be 310' WCL of 10th Ave S &
approximately 24' NCL of Maple St.
-° waRNINGF TIG
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
ENGINEERING
E
PLAT MAP; d
Storm Crain
144: Eire Hydrant
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Garage
933
ROCK WALL/BUSHES I I
PL PL
2" PE #P 24'N
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CL a CL
MAPLE S'
SIDEWALK
PL" „ ......... „°� r� �.,,s , ... ,,, , PL
PRE -INSPECTION
REPORT
,lob It:
106312930
Surface ivue
�
Date:
7/719.6��� ,�,
Address:
933 MAPLC 5T
3X5
,Jurisdiction:
Cdrl)onds
.�...._.��
City /Zip:
Edmonds98020
.....
..,.
Right of Way Permit'?
g y
d ves Na.__.
Customer:
LAUREN QR._.®..w�._._�._..._�..m�.._._..�.�.._,__..._
ANDT
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06-650-0243
Est. Start Date:
09/ ..b/lb
PM / Insp:
Kiara� M
Nays
42a-2# -r
Est. Duration:
2 I)ay
.... ...........
PHONE NUMBER
_
WORK DESCRIPTION:
_
❑
FLAGGERS tt
Construction
_Method
11V,5TALL .`. 'OF1-118"F'L ,SG'AT5TUP AND
45'G'F1-1/8"PC-
SCAif_-_XT .5CTA25010,5A
SPEED LIMIT
Open Trench ❑
alF/R,
❑ NO PARKS it
❑
Commercial (]
Trenchless L`j
PLAT MAP; d
Storm Crain
144: Eire Hydrant
o (_ v t . m
V)
LLJ
Garage
933
ROCK WALL/BUSHES I I
PL PL
2" PE #P 24'N
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CL a CL
MAPLE S'
SIDEWALK
PL" „ ......... „°� r� �.,,s , ... ,,, , PL
Work Location�
Size of Cut
Surface ivue
tU S of C L
31tl
k W �f Cl
0T.H AVE'
3X5
GRASS
'N S of CI_
_
L W of CL
_-
'N S of CL
_._ _ ___..
._
t _..,
W of CI. .........
.... ...........
_
❑
FLAGGERS tt
MPH
❑
_ _E
TROLLY LINES ❑ BUS STOP It
❑ METER HOODS it
❑
OFFICERS,!_.._
......,_....
SPEED LIMIT
-TRAFFIC SIGNAL ❑ ARTERIAL m MmWmm
❑ NO PARKS it
❑
Commercial (]
Altered Commercial
E]Leak
Repair
Service Information
❑ Template Bar
❑
Residential ❑
Altered Residential]
CP Work
Diameter
Meter
EFV
❑ Bollards 2.5" Y
Ll
MUIU-Family ❑
Replacement Service
❑
Pothole
❑ 5/8"
❑ 250
❑
1800
[] Bollards 4" #
❑
New i°vonstr. ❑
Main Maintenance
Extension
11/8"
❑ 425
(s]
2500
❑
Stub ❑
Service Maintenance
❑ 11/4"
❑ 630
❑
10,000 ❑ FUEL LINE PERMrT NEEDED
(f]
Extension ( i
Valve Maintenance
❑ 2"
❑ 1000
Fuel Line Length;
❑
Compete Sery (
Cut & Cap
Mtr Loc:
O/F/R .__
Fuel Line Diameter: ___.
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