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SEII P
DEVELONVIL'AT %'x; ROW PERMITNO,: ENG,2--01-(,e=0A)V3
ISSUE, DXTE:
RIGHT-OF-WAY CONSFRUCTION
PERMIT APPLICATION
PIZOJECT NAME: 186573913
CONTR,kciok: PSE/InfraSOUrce
Mailing Address: 1660 Park Lane, Burlington, WA 98233
..... - -----
M'lte I lice" se H: INFRASL871C2
City BUsiness License 4: NR --010840
CONTACT: Sue Sidick
#: 425-457-6353
Fax H:
Email #: SLisan.Sidick@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTEIISFCTION OF CONSTIlUCTION: 9124 Park Rd
. . .. . ..... 4
— — ----- ------
R - OW WORK ASSOCIATED WVM THE FOLLOWING TYPE OF PROJEUI':
L]
'I'Comen crejal El Subdivision City PI-0ject ❑ l-affic Collih-ol (Only)
❑ m .-Familv [XI singieFaniiiy E.1 Other
ulti SEP 2 V�
❑ ELT(PUD,VERIZON,l'SE, 92016
DIV,,CONICAST, OVN�I�)S:
is this permit part a blanket permit? El Yes I- No
AWY] LNGI/ - -------
Y,,� �(SOCIA7�-,', I =FFS
I)V,SCRfI1T1ON OF PR.OPOSED WO.RK (Be Specific): Emergency gas work follow up permit
request for gas leak repair at approx 14's 0 of Bowdoin Way & 83'E c/l of 92nd AVE W Work has been completed
1 6x4 asphalt cut in row
40 (5) YEARS?
WAS STIZEF,'I'OVEI�-1,AYEI) 'AIII'IIIN']*'f E -F VE NOE] Yeoi�'186
F1 .- F I. ' E
- - ---- -------
PAVEMENTCUT: X-1 Yes L] No If yes, indicate size of cut: 6 4
CONCRETE CUT: R Yes No If yes, indicate size of cut: ---x—
=Si(lewalk-
.
ti7A�yA DUC�ATION
AI�FJi-� ����ALI (l�tI1N BER OF' Il�I0l�THS)
L,F Y Sly+'-....._.._........ -.._ ._....------ ._ - - -. —�
Alley 72 Llrs + LF X L,F SF
�q
Parking 72 Hrs -t- L,I+ X LF SJr'
APPLICANT TO READ ANIS SIGN
*"traffic control. acid public safety shall be in accorciance with City regulations as requii cecl by the City
Engineer. Every flaoger iiiust be trained as required by (WAC) 296-155-305 a11d must have cot-tifieation
verifying completion of the required training in their possession.
*Restoration is to be in accordance with City codes and Standards. All street -cat trench work shall be
patchecl with asphalt or City approved material prior to the end of the ti,\,orl<day - NO I: XCE11TIONS.
Indemnity: The Applicant has signed an application which states he%he 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; coasts and attorney fees by reason
of granting this permit,
I Have read the above statements and umer:stand the permit regiiirenients and acknowledge that I must
follow all i-egtiif•ements in order for tl-le perulit to be valid.
09/23/20'10
S I C', N A'iI"U R
DATE
NO WORK SHALL, BEGIN PRIOR TO PERMIT ISSUANCE