ENG20170017.pdfSTATUS: ISSU
UITY OF EDMONDS
1215TH AVENUE NORTH EDMONDS,WA'98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT" MUST BE POSTED ON JOBSIT'E*
)017
Job Address: 10125 236TH PPL SW, EDMONDS Location: 10125 & 10133 236TH PL SW
PSE/Infrasource PSE/Infrasource
C/O Susan''att: Sidick C/O Susan att: Sidick
1660 Park Lane 1660 Park Lane
Burlington, WA 98233 Burlington, WA 98233
(425)457-6353
LICENSE'#: infrasl87lc2 EXP: 02/22/2017'
JOB DESCRIPTION
Replace 3/4''stw" host @ 10125 & 3/4 stw'twin @ 10133 with 1 1/8 pe host and twin (long side) at 163'W c/1 of 101st PL W &'''1T S c/1 of
236th PL SW 2 as 3x5 cuts anticipated.
DISRUP'noN INFORMATION
/ASSESSED VALUE. $0.06 PROPERTY AREA;
SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE. $0,00 STREET DISRUPTION TRENCH CUT: ( 3 X 5 )
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
INDEMNITY- 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 may be made against the City of Edmonds or
any ofils departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorney fees by reason ofgranting this permil.
THE CONTRACTORIS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A'PERIOD OFONEYEAR FOLLOWING THE FINAL
INSPECTION AND AC CEPTANCE O F THEW O RK
• 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.'
• 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 ANYEXCAVATION
CALL FOR INSPECTION (425) 771-0220'EXT. 1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
THIS APPLICATION IS NOTA 'PERMITUNTILSIGNED BY THE CITY ENGINEER OR'HISMER DEPUTY: AND FEES ARE PAID; AND RECETPTIS ACKNOWLEDGED IN
SPACE PROVIDED
Printed: FL Jan at 0 201
CGtnklt a kvaylaid 120117
RELEASED BY DATE
❑ FILE COPY ❑ INSPECTOR COPY
❑, APPLICANT COPY
• 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.
• Verify clear bore crossings
• 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.
• 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 from the 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 pemvt. 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.
E -Engineering Final
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
mmm
M m.es,(Jd�
i
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 109101354
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.Sidick@pse.com
Liability Insurance Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 10125 236 PL SW
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
El Commercial Subdivision City Project Traffic Control (Only)
❑ Multi -Family 0 Single Family [] Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes 0 No
ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : Replace 3/4 stw" host @ 10125 & 3/4 STW'
twin @ 10133 with 1 1/8 pe host and twin ( long side ) at 163'W C/I of 101 st PL W & 17' S c/I of 236th PL SW
2 asphalt/ gravel 3x5 cuts anticipated
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES NO r. 109111111
PAVEMENT CUT: ® Yes ❑ No If yes, indicate size of cut: 3 x 5
CONCRETE CUT: 0 Yes ❑ No If yes, indicate size of cut:
RIGHT-OF-WAY DURATION
AREA FTOTALICLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LFSF
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.
SIGNATURE
Susan SIdick m° w .sn"'°" DATE
01/13/2017
Contractor or Agent
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Date of Request: 01/11/17
Job number: 109101354
Job address: 10125 236th PI SW City: Edmonds Zip: 98020
Project mgr: Gayle Plaisance PM contact #: (253) 617-6013
PM email: gayle.plaisance@pse.com
Estimated job start date: 03/27/17
Estimated job completion date:
Description of work to be performed:
iAm ��� Od�'11 c� i
(Iona side) at 163' WCL of 101 st PI W and 17' SCL of 236th PI SW
Pavement cut? Yes r7No
If yes, Dimensions of Cut: Length 3 Width 5
How many cuts? 2
Surface Type asphaltigravel
Require trenching? []Yes ENO
If yes, Dimensions of trench: Length Width Depth
Method of installation:
Traffic impact:
Road closed
Lane closed
Shoulder closed
Sidewalk closed
Cell Number:
Yes ✓ No
�✓ Yes No
[Dyes No
IDYes No
How Many? 1 Direction? south
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