ENG20170036-APPLICATION.pdfOV E L)A,.i0
/ C. I S9 0
11111110011011.0111
61%, ,1�
PROJECT NAME: 106319879
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License#: INFRASL871 C2
City Business License #: N R-019840
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 22509 73rd PL W
RDW WORD ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT: �
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ® Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes ® No
ANY ASSOCIATED PEFM[TS? BLD# ENG#
DESCRIPTION OF PROPOSED WORD (Be Specific) : Work area is approx 88'N c/1 of 225th ST SW &
14'W c/1 of 73rd PL W Al;so 22' E c/I of 73rd PL W Private property . 1 3x5 paving cut anticipated and 1 2x4
on private property
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES ❑ NO ❑ Year: 1066
PAVEMENT CUT: ❑ Yes ❑ No If yes, indicate size of cut: 3 x 5
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: x_
RIGHT-OF-WAY DURATION
CLOSURE AREA TOTAL (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.
SIGNATURE
Susan SIdICk_s=S'�`°` DATE 01/30/2017
oa:e: sols oo ao o�s�:ao -0ra
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
PRE -INSPECTION REPORT
Job #: 106319879
Dote: Address:
Jurisdiction: Edmonds City /Zip:
Right ofWay Permit? [A YES [l NO Customer
Est. Start Date: I I PW1/|nap:
Est. Duration: | ldoY |
* [ItAii, � �' II(AN0 t N[ �1116 �,
22509 73rd P1 W
Edmonds 98026
Maria Ramos
425-791-5979
,Jordan McLean
PM PHONE NUMBER
425-563-3703
WORK DESCRIPTIOM
Construction Method
Trenchless
New Construct
Existing
PLAT MAP: 165.070
PA
Stub* 33'
22509
all OH.
No sidwalk
5/8" PE SVC to Neighbors
WORK LOCATION
Size
of Cut
Surface Type
8—
FLAGGERS #
MPH
TROLLY LINES
BUS STOP #
METER HOODS #
OFFICERS #
SPEED BMiT
TRAFFIC SIGNAL
ARTERIAL
NO PARKS #
commercial
Altered Commercial
Leak Repair Service Information
El Template Bar
Residential
Altered Residential
CP Work Diameter Meter
EFV Pressure
E] Bollards 2.5" #
Multi -Family
Replacement Service E]
Pothole E] 5/8" E]
250 F] 1800 6" WC
Bollards 4" #
E]
New Constr. F]
Main Maintenance
Extension 1-1/8" F]
425 2600 2#
n
Stub F]
service maintenance
1-1/4" f—]
630 10,000 25#
FUEL LINE PERMIT NEEDED
Extension E]
valve maintenance
E] 2" El
1000 E] 775
Fuel Line Length:
Compete Sery 0
Cut & Cap I Meter Loc:
OLF 03 1
Fuel Line Diameter:
4I
4
B'U'T
SOUND
ENERGY
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 14' WCL Of 73rd PI W & 88' SCL of
225th ST SW.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
a PARKING
rind �.v;avn w
22509
Q
ti
cli
0
C2
LEGEND
ONE LANE p
28' TRAFFIC CONE
ROAD N
0o AHEAD
® BORE PIT
ROAD
TRAFFIC FLOW
WORK N
AHEAD
WORKVEHICLE
SIGN LOCATION
�4 WARNING FLAG
r
J
4
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 22' ECL of 73rd PI W & 88' SCL of
225th ST SW.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
22509
LEGEND
28' TRAFFIC CONE
® BORE PIT
TRAFFIC FLOW
N
WORKVEHICLE
IF ME
p
ROAD
U'EAD
SIGN LOCATION
1
�4 WARNINGFLAG
M