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Notes: SOUND
1, All signs and spacing to conform to file MUTCD F'NL,'.-R Y
and City of Edmonds standa;ds. IS
2. Allsidewalks, driveways, exits and egresses shall be Job006315282
Completely clear unless Otherwise indicated. 22607 92ND AVE W EDMONDS, WA
1, Channeli7ing devices are 28" traffic cones, SEP] EMBER 15, 2016
Street I 1
4. Sign size, can be a mininium of 48" x 48" and shall not of sally-bergman@pse,ccm
398-6003
obstruct pedestrian access, (425)
5, Crew is required to leave a minimum of 1'I' for traveling
lone width.
6. Alert affected residents and businesses, Puget Sound Energy
7, Work to take place betwPen 9 a.m. and 4 p.rn, Traffic Control supervisor:
8. Work area will be 350' NCL of 2271H S f SW & Gregory Hamood
approximately 19'WCI- of 92ND AVE W. Card No, 008997
9. If used, place NO -PARK signs 72 hours in advance Card Exo. 0811312019
ccm
of the day that the work is to be done. (425)424-6,125
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RISIDENT(S) WrI or. IWO '17)
0e Po'iS1RE)V'W0'R' 1LEGEND
URJV:Wky CL OW"r, --- ......... . —, --
R�, 28 -TRAFFIC CONE
BORE PIT
TRWROFLOW
FI A6,01"R
WORK VFHIG, r
SIGN LOU, I LON
4. —1111-111113
...........
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PRE -INSPECTION REPORT
Work Location
Job#:
106315282
�_...,
SIze of Cut:
Date:
/t>116
Address:
22607 92nd Ave IN
W�f CL
Jurisdiction:
Edmonds
City / Zip:
Edmonds gt�020
_.. ..-...
� 7
Right of Way Permit? �..C1
._ -.�_ L NO
� YF.;
Customer:
Rut I1
&
Est. Start Date:
PM / lns
. _
ry£206-390-3632 ------
Andrew Qounsgarci
...
"EM F
4257965
Est. Duration:
'N S of CL
_.....
.,SHONE"NUMBF"
afro "I Sr PAC q2AD Nt00e
11ATQ VS
E W of CL
_
....
Construction Method
VVGf�{C.-Di_S�RIF?TIOtJ;
OLYMPIC,
2
25 MPFI
-
TROLLY LINES
❑ BUS
STOP #
N
m
❑ METER HOODS #
Open Trench
lnz0a11 a .139' 1-118
service, 5et a 925 meter.
SPEED LIMIT
❑
Trenchless Cj
..... _...�....�,...mW....._,....�.._ _,
Work Location
PLAT MAP:
165068
�_...,
SIze of Cut:
Surface Typq
PL
of OL.
Q 6 h v
91 t Ave -W,_ Av& 19 -.
W�f CL
80 1-1/8" PE Extension
A425 MSA
Ave., _
�
� Xy
5,� tf„
PE Stub #3k i19
NSofCL.
........... .
&
_ . _
EWofG
'N S of CL
_.....
afro "I Sr PAC q2AD Nt00e
11ATQ VS
E W of CL
_
....
,._.
OLYMPIC,
2
25 MPFI
h_]
TROLLY LINES
❑ BUS
STOP #
N
m
❑ METER HOODS #
[ f
OFFICERS
OFFICERS #
0
SPEED LIMIT
❑
TRAFFIC SIGNAL
''
❑ ARTERIAL
a 1st
Ave Vii
Work Location
SIze of Cut:
Surface Typq
of OL.
Q 6 h v
91 t Ave -W,_ Av& 19 -.
W�f CL
_ ....._9�n��
Ave., _
�
� Xy
� dirt
NSofCL.
........... .
&
_ . _
EWofG
'N S of CL
_.....
& _
E W of CL
_
....
,._.
FLAGGERS fk
2
25 MPFI
h_]
TROLLY LINES
❑ BUS
STOP #
N
m
❑ METER HOODS #
[ f
OFFICERS
OFFICERS #
0
SPEED LIMIT
❑
TRAFFIC SIGNAL
''
❑ ARTERIAL
(_� tV0 PARKS #
Commercial
.�..
Altered Commercial
n....
E]Lc
>air��--
Leak Repair
.. v . _...�...�..,___...�..._......._�.��,.._..
Service Information
......,�_.._____.�_.�...�...�.....M..
-remplate Bar
�._�
Residential
Altered Residential
Altered �
❑
CP Work
�
Diameter
Meter
EFV
-
❑ Bollards 2.5" #
El
Multi -Family
(�
Replacement Service
[�
Pothole
❑
5J8"
❑ 250
❑
1800
Bollards 4" 11
t^.7
New Constr.
F]main
Maintenance
❑
Extension
❑
11/8"
n 425
n,2600
_...�
[ ]
Stub
❑
Service Maintenance
❑
11/4°
[] 630
10,000 ❑ FUEL LINE PERMIT NEEDED
❑
Extension
❑
Valve Maintenance
(�]
2"
❑ 100o
Fuel Line Length:
[j
Compete Seiv
[)
Cut R Cap
Mtr
Loc:
_ _ _
Fuel Line Diameter:
?2604
2608
612
6!0" PE
1990
10 STW-u
1970
618" PE
1302
C:) L,
O
4 75 S
N 98/
N
v
v,
N
N
w 5/8"628'S
N 2000
N
N 1970
1/2'19114
1970
N � 1cj'1
N
Is
0
N
N
N
1983
a
9
1"VC
1;jj
SEEP 2 0 2016
ROW PERMrr NO.: E NG,_
`17"�" MES
�J_wlvd 'A.R ISSUE DATE:
RIGHT-OF-WAYCONSTRUCTION
PERMITAPPLICATION
PROJEC71' NAME: 106315282
CON,rRACTOR: PSE/Infrasource
Mailing Addt,ess: 1660 Park Lane, Burlington, WA 98233
StateLicenseg: INFRASL871C2
_ . . . . . ... .........
City Business License #: NR -019040
CONTACT: Sue Sidick
425-457-63503
. .. .......
Susan,Sidick@pse.corn
❑ Liability
190 (p I
ADDRESS OR IWERSECTION OF CONSTRUCTION: 92 AVE VV
ROW WORK ASSOCIATED WITHTHE FOLLOWING"TYPE OF PROJECT:
(Ii 7isloIt � ffie Conti-ol (0111y)
-otilillerei, City PI-0ject -a
S11
L] Multi-Tamily (XJ Single Family F—] Othe"
EUC(P-UI), VERIZON, PSE, SEP 2 0 2016
CA. MC.ASr, ovws.[)):
is this permit part of blanket perrrdt? El Yes leo
ANY S
B1,10 ENG4 ..... .
AS00ATED PERM.1'
T\41�i
DESCRIPTION OF PROPOSED WORK (Be Specific)
Permission requested to install new 1-1/8" PE
gas service at approx 350' N CII of 91 AVE W & 19' W c/l of 92 AVE W 1 3x5 cut in the dirt anticipated
INTHE LAST FIVE 166
--YES _ . ......
PAVEMENT CUTT: Yes No If yes, indicate size of cut: 3 5
CONCRETE CUT: Yes No If yes, indicate size of cut: ---X—
RIGHT-OF-WAY
ARE ATOTAL
CLOSURE
lk
Sidewa48 Hrs + LF X LF SF
Alley 72 Hrs + LFX LF SF
Parking 72 Hrs + LF I X LF SF
DURATION
(NUMBER OF MONTHS)
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 aelcnowledge that I must
follow all requirements in order for the p �rmit to be valid.
09/19/2016
SIGNATURE 'Q
DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE