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Job #: 106315734
Date: 9/19/16
Jurisdiction: Edmonds
Right of Way Permit? E YES ❑ NO
Est. Start Date:
Est. Duration:
12/02/16
I DAY
PRE -INSPECTION REPORT
Address: 18816 90TH PL W
* ri' U (.� L' If _5 0 U N,' �� L -
City / Zip: EDMONDS 98026
Customer: Keith 425-771-7202
cusTPRO"i NOUN—
PIVI / Insp: Kictra Hays 425-213-9205
PHONE NUMBER
Construction Method
WORK DESCRIPTION:
INSTALL 15'OF 1-118" PE SCA TSTUR AND 90' OF 1-118" PESCA TEXT SETA250 MSA
Open Trench E]
Trenchless
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PLAT MAP:
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188TH ST SW
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❑ FLAGGERS # MPH ❑
TROLLY LINES
❑ BUS STOP # ❑ METER HOODS #
❑ OFFICERS # SPEED LIMIT ❑
TRAFFIC SIGNAL
❑ ARTERIAL ❑ NO PARKS #
❑ Commercial ❑ Altered Commercial E]
Leak Repair
Service Information ❑ Template Bar
Residential E] Altered ResidentialEj
CP Work
Diameter Meter EFV ❑ Bollards 2.5" #
❑ Multi -Family 0 Replacement Service Ej
Pothole
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5/8" 250 E] 1800 E] Bollards 4" #
New ❑Constr. E] ❑Main Maintenance E]
Extension
E]
11/8" ❑ 425 2600
❑ Stub ❑ service maintenance
E]
11/4" 0 630 ❑ 10,000 0 FUEL LINE PERMIT NEEDED
Extension ❑ valve maintenance
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2" ❑ 1000 Fuel Line Length:
P Compete Sery E] Cut & Cap
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RECEIVED
SEP 3 0 2016 ROW PERMIT NO.: ENG
b1E VE- I.. C)FA&I Lrgj' `31:_r1VA,ES ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 106315734
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASI-871C2
City Business License #: NR -019840
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax
Email 11: Susan.Sidick@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS Oil INTERSECTION OF CONSTRUCTION: 18816 90th PL W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
E:❑I Commercial Subdivision City Project E] Traffic Control (Only)
❑ Multi -Family 0 Single Family ❑ Other nF-',m',c.E1VED
❑ EUC (PUD, VERIZON, PSE, SEP 3 0 2016
COMCAST, OVWSD): ENGINE""Ei"INC�*4 DIVISlON
Is this permit part of a blanket permit? ❑ Yes E*1 No
[A N Y ASSOCIATED P PERMITS? I �TS ? D
DESCRIPTION OF PROPOSED WORK (Be Specific) : -Permission is requested to install new
1 18 gas service @ 18816 90th PL W at approx 170' S c/l of 188th ST SW & 16' E c/I of 90th PL W
WAS STREET OVERI_,AYED WITHIN THE LAST FIVE (5) YEARS? YES 0 NOE] Year: 106h
PAVEMENT CUT: Yes E No If yes, indicate size of cut: 3 x 5
CONCRETE CUT: ❑ Yes F-1 No If yes, indicate size of cut: ___x_
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.
Dianauv s�o�ea 6y Se=an s�a�k
DN'. cn=Susan Sitlick. o=PuOel Sound Energy, ou=S�reel Use
SIGNATURE Susan Sidick Pe,n,.n9ema�=sesa�skk@0aecemc=DS DATE
09/26/2016
Date: 2016.09 30 01'.5'1:30-01'00'
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE