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ROW PERMIT NO.: ENG Zcj(,g 0,45 2
ISSUE DATE:
liv& L S9 d
PROJECT NAME: 108594409
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871C2
City Business License #: NR -019840
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan. Sid ick@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 22625 Hwy 99
FROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
ElCommercial ElSubdivision ❑ 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) : Work area is approx 340'N c/i of 228th ST SW &
24'W c/I of 76th AVE W. To cut and cap gas service 1 3x5 concrete cut anticipated.
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year: 1087EI
PAVEMENT CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
CONCRETE CUT: ® Yes ❑ No If yes, indicate size of cut: 3 x 5
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.
D"pna5y 59netl bi Susan SNct
Susan Sidick a�m-��°s°_asa�E �.s"�,°a° 10/27/2016
SIGNATURE 0�D1 emMO a:30U Wamm,c+US DATE
Daae: 2016.090 OiSi:]0 �OT00'
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
PRINT ON
11X17" SHEETS ONLY
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7. Work to take place between 9 a.m. and 4 p.m.
8. Work area Will be 24' WCL of 76th Ave W & 340' NCL of
228th St SIN.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done,
GNUMM"M 0=1
PARKING
_='�= C)
'M AS NOT
NE
20
228TH ST SW
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55170 d0 80
351451 30 - 60
25/301 20 40
LEGEND
28'TRAFFIC CONE
BORE PIT
TRAFFIC FLOW
YORK
VEHICLE
SIGN LOCATION
WARNING FLAG
Notes:
1. All signs and spacing to Conform to the MUTCD
and City of Edmonds standards.
2. All sidewalks, driveways, exits and egresses shall be
completely clear unless otherwise Indicated.
3. Channelizing devices are 28" traffic cones.
4. Sign size can be a minimum of 48" x 48" and shall not
obstruct pedestrian access.
6. Crew is required to leave a minimum of 11' for traveling
lane width.
6 Alert affected residents and businesses
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7. Work to take place between 9 a.m. and 4 p.m.
8. Work area Will be 24' WCL of 76th Ave W & 340' NCL of
228th St SIN.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done,
GNUMM"M 0=1
PARKING
_='�= C)
'M AS NOT
NE
20
228TH ST SW
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55170 d0 80
351451 30 - 60
25/301 20 40
LEGEND
28'TRAFFIC CONE
BORE PIT
TRAFFIC FLOW
YORK
VEHICLE
SIGN LOCATION
WARNING FLAG
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