ENG20160373.pdfSTATUS: ISSUED ENG209 60373
• 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 ofEdmonds .traffic control requirements.
• Applicant shall repair/replace all damage to utilities or fi•ontage improvements in City right-of-way per City standards that is
caused by or occurs during the, permitted project.
• Sound/Noise originating fromternporary construction sites as a result of construction activity are exempt fi•omthe noise limits
of ECC Chapter 5.30 only during the hours of7:00am to 6:00pmon weekdays and '10:00amand 6:00pm on Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originating fi•omconstruction 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 ofhis 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 fi•omthe 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 DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINALINSPECTION APPROVED DATE: INITIAL:
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PRE -INSPECTION REPORT 111,16 0 SWIJIM EWPOY
Job #:
106308762
Instail 75' -11/4" 1/5 service to A425
on 3MM (for future tenants), "Dave Lima to meet
Date:
8/22/16
Address:
624Galey St, #2 (5a Ile, -15 Llymaj
Jurisdiction:
City of Edmonds
City / Zip:
Edmonds, WA 98020
Right of Way Permit?
El YES ❑ NO
Customer:
Linda Chapman
425-898-6661
Est. Start Date:
10/15/16
PM / Insp:
Lisa Grif f ith/b. Lima
TSP-MV617T
Est, Duration:
1112 days
628
PHONE NUMBER
Construction Me ho
Open Trench 0
Instail 75' -11/4" 1/5 service to A425
on 3MM (for future tenants), "Dave Lima to meet
crew onsite far Jab start.
Trenchless
PLAT MAP:
Daley
S
624, i< A 125 MSA
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628
y
tivater EY
(45P
EXISTING GAS MAIN, 3'N/SOL
2" PIE IP §1258-8'
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Work Location
Size of Cut
y e
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FLAGGERS # 10 MPH F]
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TROLLY LINES ❑ BUS STOP # ❑ METER HOODS #
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OFFICERS # SPEED LIMIT ❑
TRAFFIC SIGNAL ❑ ARTERIAL Q NO PARKS #
n
Commercial n Altered Commercial ❑
Leak Repair Service Information E] Template Bar
[2)
Residential n Altered ResidentialE]
CP Work 01ameter Meter EFV n Bollards 2.5" #
❑
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Multi -Family El Replacement Service El
Pothole ❑E] 5/8" ❑E] 250 1800
0 Bollards 4" #
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New Constr. n Main Maintenance. ❑
Extension 0 11/8" R] 425 Q 2600
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Stub [j service maintenance
Ej 11/4" [:1 630 Fj 10,000 El FUEL LINE PERM NEEDED
Extension E] Valve Maintenance
n 2" ❑ 1000 Fuel Line Length:
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Mtr Loc: OL Fuel Line Diameter:
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SEP 13 2016
L iw,t�;
ROW PERMIT NO.: ENGJt 0 :3 7-3
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 106308762
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871 C2
City Business License #: NR -019840
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 624 Daley St & 7th AVE N
ROW WORK 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) : Permission requested to install new 1-1/8" PE
gas service off of the alleyway at approx 7.5' N c/I of a;;ey way & 310' W c/I of 7th AVE N
1 3x5 cut in asphalt anticipated and 1 2x2 pothole over water.
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year:106?1
PAVEMENT CUT: ® Yes ❑ No If yes, indicate size of cut: 3 x 5
CONCRETE CUT: 0 Yes ❑ No If yes, indicate size of cut: x_
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 I must
follow all requirements in order for the permit to be valid.
SIGNATURE - DATE 09/13/2016
Contractor or Agent -
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE