ENG20160450.pdf7 ED
OCT 2 6 2016
ROW PERMIT NO.: ENGADLlr�—i-l�o
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION RECEIVU,
PERMIT APPLICAT.ION OCT25 2016
PROJECTNAME: 892043917
CONTACT: Sue Sidick
C 0 �1 'RX ( "T -0 —R:—
PSE/Infrasource P11011c #: 425-457-6353
Mailing Addi-ess: 1660 Park Lane, Burlington, WA 98233 Fax
- – ----------------- - ---
. . . . . ............... - --
State "'Ce"set': INFRASL871C2 Susan.Sidick@)pse.corn
City BusinessLicense -9: NR -019840
Bonded
= "m -ility Insin-ance T7T
ADDRESS OR INTERSECTION OF CONSTRUCTION: 8424 Bowdoin Way
LI. I RO I ASSOCIATED wj,rH THE FOLLOWING TYPE OF PROJECI.
Subdivision El City Project El Ti'affic Conti-ol (0111y)
0 Multi-Farnily FX -1 Single Family [:1 Ortheli-
El FAX (PUD, VERIZON, PSE,
COMCAST, 0VWSD):
Is this peri -nit part of a blanket permit? E] Yes No
-I_XFF--D PER
DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 270'W c/1 of 84th Ave
W on Bowdoin Way, 1 3x5 paving cut anticipated Please rush remove 5/8 pe gas service, from storm storm drain and repair
LWAS STILE ET OVERLAYED WITHIN THE LASTFIVE (�) YE ..
AILS? VE�Lj_NO ❑ Y
PAVEMENT CUT: Yes ❑ No If yes, indicate size of eat: 3 X 5
CONCRE'TE CUT: ❑Yes ❑ No If yes, indicate size of cut: .—X—
RIGHT-OF-WAY DURATION
AREA TOTAL
CLOSURE (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.
Susan Sidick 10/26/2016
SIGNATURE DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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Storm Single Work Order
Structure ID: :13-618 13-63 Work Order Number 4240
Address Number 8424 BOWDOIN WAY Confined Space No
Date Reported 1/29/2016 Flaggers No
Issue Storm -Illegal Boring Vactor No
Activity Remove Boring
Location
Details Gas line bored through the storm pipe. 87' NE of 13-63.
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Total Work Orders
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