ENG20160394-2.pdfOf EIJ
CITY OF EDMONDS
1215TH AVENUE NORTH - EDMONDS, WA 98020
I PHONE: (425) 771-0220 - FAX: (425) 771-0221
c. 1 g9
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20160394
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Permit Number: ENG20160394 Expiration Date: 04/03/2017
Job Address: 22612 92ND AVE W, EDMONDS Location: 22612 92nd Ave W
PSE/Infrasouree
P SE/Infrasource
C/O Susan att: Sidick
C/O Susan att: Sidick
1660 Park Lane
1660 Park Lane
Burlington, WA 98233
Burlington, WA 98233
(425)457-6353
LICENSE #: infrasl871c2 EXP: 02/22/2017
Install new 1-1/8" PE gas service at approx 350'N c/1 of 91st Ave W and 19'W c/1 of 92nd Ave W. 13X5 cut in dirt anticipated
DI[SRUPTION INFORMATION
ASSESSED VALUE: $0.00 PROPERTY AREA: 0
SIDEWALK: (ONO DURATION IN MONTHS: 0 FEE: $0.00 STREET DISRUPTION TRENCH CUT: ( 0 X 0 )
PARKINCr. ( 0X0) DURATION IN MONTHS: 0 FEE: $0.00 YEAR OF OVERLAY: 0 FEE: $0.00
ALLEY: ( 0X0) DURATION IN MONTHS: 0 FEE: $0.00
INDEMNITY The Applicant has signed an application which states he/she holds the City ofEdmonds harmless from injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City ofEdmonds 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.
THECONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FORA PERIOD OFONEYFAR FOLLOWING THEFINAL
INSPECTION AND ACCEPTANCEOF THE WORK
• Traffic Control and public safety shallbe in accordance with City regulations as required by the C Engineer. Every flagger n ust
be trained as required by (WAC) 296-155-305 and nest 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 shallbe 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(1-800-424-5555) BEFOREANYEXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NO TIC E REQUIRED FOR ALL INSPECTION REQ UES TS
APPLICATIONAPPROVAL
THIS APPLICATION IS NOTA PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Tuesday, October 04, 2016
CAz�&� 101312_01(o
RELEASED BY
DATE
0 FILE COPY ❑ INSPECTOR COPY ❑ APPLICANT COPY
STATUS: ISSUED ENG20160394
• 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 priorto work start.
• Conformto approved working drawings and Traffic Control plan.
• Verify clearbore crossings
• Utility patch restoration to be in accordance with Edmonds Standard detail F2.3
• 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 -0f --way per City standards that is
caused by or occurs during the permitted project.
• Sound/Noise originating fromtemporary construction sites as a result of construction activity are evmpt fromthe noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 6:OOpmon weekdays and 10:00amand 6:OOpmon 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 fromany and all claims for damages of
whatever nature, arising directly or indirectly fromthe 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:
FINAL INSPECTION APPROVED DATE: INITIAL: