ENG20160514.pdfer.E,
CITY OF'EDMONDS,
121 5TH A VENUE NORTH - EDMONDS, WA 98020
t�� I PHONE: (425)771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE,
STATUS: ISSUED ENG20160514
Permit Number: ENG20160514
Job Address: 18808 80TH AVE W, EDMONDS
COMCAST OF WA, LLC
1525 75TH AVE SW, #200
Attn: Mike Fontenot
EVERETT, WA 98203
Expiration Date: 07/04/2017
Location: 18808 80th Ave W
Cablecom LLC
1316 Bonneville Ave
Bldg, A
Snohomish, WA 98290
LICENSE 4: CABLEL*971DP EXP: 08/21/2017 _
Repair/ replace broken storm drain from damage caused byroad crossing and conduit placement. Will need to dig up 5X10 area to
access storm and move Comcast conduit minimum of 36" below storm. Restoration to meet or exceed city standards. Storm line to be
inspected by city staff prior; to backfill.
ASSESSED VALUE: $0;00 PROPERTY AREA; 0
SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0;,00 STREET DISRUPTION TRENCH, CUT: (5 X 10 )
PARKING: ( 0X0) DURATION IN MONTHS: 0 FEE: $0;00 YEAR OF OVERLAY: 0 FEE: $0;00
ALLEY: ( OX0 DURATION IN MONTHS:_ 0 FEE: $0,00
1NDEMIWTY The Applicant has signed an application which states he/she holds the City of Edmonds harmless from injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that maybe made against the City of Edmonds 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 FOR PERIOD OF ONEYEAR FOLLOWING THEFINAL
INSPECTION AND ACCEPTANCE OF THE W ORK.
a 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
possesion.
0 Restoration is to be in accordance with City codes. All street -cut trench work shall be 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) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220;EXT. 1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
Utn
RELEASED
SPACE PROVIDED„
al 1
Printed: Wednesda ;;Jams
DATE
❑ FILE COPY ❑ INSPECTOR COPY ❑ APPLICANT COPY
201
• 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; prior to work start.
• Conform to approved working drawings and Traffic Control plan.
• Utility patch restoration to be in accordance with Edmonds Standard detail E2.3
• 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.
• City storm line to be inspected by city staff prior to backfill.`'
• Applicant "shall repair/replace all damage to utilities or frontage improvements in City right-of-way per City standards that is
caused by or occurs during the permitted project.
• Sound/Noise originating from temporary construction sites as a result of construction activity are exempt fromthe noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 6 00pm on weekdays and 10:00am and 6:00pm on 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 from any and all claims for damages of
whatever nature, arising directly or indirectly from the 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!'
INS varioNS
• &Traffiic Control
• E-Curb/Gutter Pre -Pour
• E-Sidewalk'Pre-Pour
• ErStormLin eInspection;
• E -Engineering Final
• E-Curb/(litter Post -Pour
• E -Sidewalk Post -Pour
PARTIALINSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:`
FINAL INSPECTION APPROVED DATE: INITIAL:
LD�I pe -x.
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gg w .ra w.a p E ,,
DEVE-Of"M �`_`N m ERV1Cr,.`S
ROW PERMIT NO.: ENG 0t — 051�
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 227036 - EDMONDS STORM REPAIR
CONTRACTOR: Cablecom LLC
Mailing Address: 1316 Bonneville Ave Bldg A
Snohomish„ Wa 9£3290
�............ .......... ..... — __. _—.. .w........,
State License #: CABLEL-971 DP
City Business License #: NR -021818
RECEiva)
,DEC201
Comcast - Cody f w° I t" DIVISION
CONTACT' Cablecom LLC - &vnshine Cnabbs
Phone #: 360-454-3163
Fax #: .. 4 ........... .
IT Cablecom LLC- sunshine. rat)bs(acableconol c etr ..
Email #: corn
..m......._ .... _. ..._
d
Liability Insurance r� Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 18808 80th Ave W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
'Commercialm „ Subdivision City Project �.,LL Traffic Control (Only)
Multi -Family Single Family
E EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
El Other
❑ Yes ❑X No
ANY ASSOCIATED .......-.
- -
M. .
mm....RMITS?BLD# w . ENG#
DESCRIPTION OF PROPOSED WORK Be Specific):
Repair/replaced broken ^storm drain from damaged caused by road crossing & conduit placement.
Will need to dig up 5x10 area to access Strom and move Comcast conduit minimum of 36" below
storm. Restoration to meet or exceed city standards.
WAS STREET OVERLAYED WIT H.,_ _
THIN THE LAST FIVE (5) YEARS YFS I�w_ � NO� XI Year
PAVEMENT CUT: Rx Yes ENo If yes, indicate size of cut: w5 x 10
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
APPLICANT TO READ AND SIGN
A Rti nW+'.vy,�. w✓Y'�'YWVY'Ylll'I.�.YI&WWN'WEHI � YYYAWA�'.0'�IMW1W+'MYM''M'I�YIpWI�PUN9 N9 IJIMJiN�mIIi UU ��� �'WPMWA%V.�FMBNf VNJk(a6PpNA..J9if�M�S.M.kVf:'�nY.WP.➢."eWtM�1.NVAW Nt'�WAWN�rvX�'WPMGM�P,^AA.1",0.� M WWMYNMM.'�MpiVU.WY"ftYtw MM.1�WRMW1�1'MV�FThC UUpANWU�"IWM 'NN'�015kN�P.V�V;,'W
*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.
SIGNATURE �,`.� DATE 12-22-2016
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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