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ISSUE DATE:
PROJECT NAME: 887033242
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871C2
City Business License #: N R-019840
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
F-1 Liability Insurance E:1 Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 23926 74th Ave W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
R Commercial 0 Subdivision F] City Project Ej Traffic Control (Only)
R Multi -Family FX] Single Family F] Other
F1 EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? El Yes W No
� ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORI,,,' (Be Specific) : Emergency gas leak repair follow up permit
Cross bore through sewer. 1 3x5 paving cut work has been completed
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES 0 NO E] Year: 887b
PAVEMENT CUT: Z Yes F-1 No If yes, indicate size of cut: 3
CONCRETE CUT: F1 Yes F] No If yes, indicate size of cut: —
x5
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
*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 Susan Sdick � 'U�@ � =US e"°� DATE 01/06/2017
Data: 3016 0930 073].10 -0T00'
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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ENERGY
Job#887033242
I 23926 74TH AVE W EDMONDS, WA
JANUARY 9, 2017
Ov3Hv Sheet 1 of 1 sally.bergman@pse.com
o NNOM I (425) 398-6003
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,4IA TRAFFIC FLOW
IFLAGGER
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RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY /
DRIVEWAY CLOSURE:
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241 ST ST SW %
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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.
5. Crew is required to leave a minimum of 11' for traveling
lane width.
6, Alert affected residents and businesses.
7. Work to take place between 9 a.m. and 4 p.m.
8. Work area will be APPROX, 12' WCL of 74TH AVE W &
APPROX. 268' NCL of 241ST ST SW.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55"20
80
35/45136 60
25/30 20 40
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74TH AVE W
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