ENG20160291.pdfMay 24 16 09:36a Sutter Paving
OF EDAj,-,
425-391-5420 P.1
ROW PE NO.: ENG
ISSUE DATE: _Q
RIGIIT-OF_WAy
"VC5 Is go CONSTRUCTION
PERMIT APPLICATION
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f a) M t-" (� S' VV A `-i 00 2- L CONTACT:
,CONTRACTOR- A or �u �jjk
Phone INUfflug Adaress: 77X ��J-e —0--
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City Pro—ject
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0 NIalti-Fam" N Single Family EJ Other TilifieWatro (Only)
0 EUC(P'tTD VERIZON,PSE,
COMCAST, 0'
VWSD),
Ts this Permit part of a blanket permit? El Yes Jab Number
LA.NY
ATED PERI TS`?
DESCRIPTION OFpRopOSED WORK (Be Specific)
11c. 4 - -31 V C- it,)
N •H
YED ritlrH
V- JUANT M-Ei
YEARS? Y.ESEj- N
PA'VTA4E, NT CUT.- --OEQ NY e --ar
CONCRETE CUT: E] Yes❑ No - If yes, indicate size of cut:
Y" E] No If Yes, indicate sire of cut:
May 24 16 09:36a Sutter Paving
RIGHT-OF-WAY
CLOSL32E AREA TOTAL
Sidewalk 48 Hrs +
LF i LF
SF
Alley 72 Hrs + `_ SF
F .��..
LF SF
Parking 72 lairs + LR
I SF
425-391-5420 p.2
DURATION,
(NUMBER OF MONTHS)
—'� A'��ICANT TO► READ AND SIGN
*Traffic control and public safety shall be in accordance with City regulations as required ~~�
ngineer. Every flagger must be trained as required b q d the City
verifying completion oa'the required training in their possession. 296 15Y -34S and must have certification
*Restoration is to be in accordance with City codes and Standards. All street -cut t
Patched with asphalt or City approved material prior to the end of the work -da rez1cla work shall be
y —IVO EXCEPTIONS.
I have read the above statements and understand the permit requirements and acknowl
follow all requirements in order for the permit to be valid -
edge
I
that .f ust
s
SIGNATURE
3i
tr r or Agent DATE Q J
NO YORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE,
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ROW PERMIT NO.:ENG .4- �1' 091
ISSUE DATE:
PERMIT APPLICATION
PL- S
PROJECT NAME: VJA -vboL-�. CONTACT:
CONTRACTOR: ?1 0 Vk I&M, r 6- dl/V t -L as Phone .58 a - 7 Y09
Mailing Address: Fax#: q;Z5-397- ?X41
State License #: Email
om I 01�;- N W
City Business License --E9;C!abiH1y insurance
onded
ADDRESS OR INTERSECTION OF CONSTRUCTION:
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
L1 Commercial Subdivision LJ City Project —Traffic Control (Only)
El Multi -Family to Single Family 'El Other
0 EUC (PUD, VERIZONq PSE,
CONICAST, OVWSD):
Is this permit part of a blanket permit?
El Yes D No Job Number
ANY ASSOCIATED PERMITS?---, I BLD# ENG#
ti
DESCRIPTION OF PROPOSED WORK (Be Specific):
&ALI S�4v%e
IV\ co"""V' '40 k*',v&.J61' -5.Q tap—
ym'w ` n.
ti. LJCl' f)
.. .......
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5YE S? YES Y--0 NO ET�Vear=
PAVEMENT CUT: 0 Yes 0No
CONCRETE CUT: 0 Yes [9'No
If yes, indicate size of cut: —X
If yes, indicate size of cut: .-.., x
RIGHT-OF-WAY
DURATION
AREA
TOTAL
CLOSURE
WUMT3ER 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 grained 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,
1�IJE1V[l7'Y: The A licar�t .has si ned an licat't n whit 7 sta he/she hold the City of Edmonds
JCd___. A 1 • n
costs anti attormy fees by reason of granting.this pernift.
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. rw Z&j (Q
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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