ENG20170058.pdfCATY OF EDMONDS
121 5TH AVENUENORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 FAX: (425) 771-0221
*PE IST MUST BE POSTED ON JOBS TE*
STATUS: ISSUED ENG20170058
Permit Number: ENG20170058
ExpirationDate: 08/23/2017
Job Address: 22422 96TH AVE W, EDMONDS
Location: 22422 96th AVE W
APPLICANT
PSF/Infrasource
CONTRACTOR
PSE/Infrasource
GO Susan att: Sidick
C/O Susan att: Sidick
1660 Park Lane
1660 Park Lane
Burlington, WA 98233
Burlington, WA 98233
(425)`457-6353
k area is approx l
Ic2 EXP'. 02/22/201
g cut anticipated. to install gas s
ASSESSED VALUE: $0,,00 PROPERTY AREA: 0
SIDEWALK: (OXO DURATION IN MONTHS: 0 FEE: $0;00 STREET DISRUPTION TRENCH CUT: ( 3 X 5 )
PARKING: (-0X0 J DURATION IN MONTHS: 0 FEE: $0„00 YEAR OF OVERLAY: 0 FEE $0.00
ALLEY ( 0X0 1 DURATION -IN MONTHS: 0 FEE: $0,00
INDEMNITY The Applicant has signed an application ivhich stales 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 permit,
THECONTRACTOR'IS,RESPONSIBLEFOR WORKMANSHIP AND MATERIALS FOR A PERIOD OFONEYEAR FOLLOWING,THEFINAL
INSPECTION AND ACCEPTANCE OFTHEWORK
• 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 pemuit 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
APPLICATION APPROVAL
THIS APPLICATION IS NOTA PERM[TUNT[L SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED,
Printed: Thursday,,,Fcbruai 23,2017
.21312-017
RELEASED BY DATE
❑ FILE COPY ❑ INSPECTOR COPY ❑ APPLICANT COPY
ENG20170058
0 Restore ROW to City standards
0 Restore Landscape to like or better conditions.
0 Call for locates of underground utilities prior to any excavation...
0 Alert affected residents and/or businesses prior to work start.
0 Conform to approved working drawings and Traffic Control plan.
Verify clear bore crossings
0 Utility patch restoration to be in accordance with Edmonds Standard detail E2.3
0 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 fi•ontage 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.
0 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.
I- INSPFCTIONS
• F Engineering Final
PARTIAL INSPECTIONDATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
of EDA4
a
RECEIVED SCANNI.' D
FEB 17 2017 17 207
BUILDING
ROW PERMIT NO.: ENG C;v�O
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 106320765
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871 C2
City Business License #: NR -019840
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan. Sid ick@pse.com
Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 22422 96th AVE W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial El 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 W No
ANY ASSOCIATED PERMITS? I I BLD#_ ENG#
..... � � ��.,,�.........
DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 192'S c/1 of 224th ST SW
& 20'W C/1 of 96th AVE W. 1 3x5 paving cut anticipated. to install gas service
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YESNO Year: 106:61
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
AREA TOTAL
CLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF :SIF
.............. 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.
Susan S1d1CkDlila9snetl WS aA S:dkk
02/18/2017
SIGNATURE m�
ATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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Job #:
Date:
Jurisdiction:
Right of Way Permit?
Est. Start Date:
Est. Duration:
106320765
2/6/17
Edmonds
❑Q YES ❑ NO
PRE -INSPECTION REPORT
0 P1...;bE.T ENLYGY
Address: 22422 96TH Ave W
City / Zip: Edmonds 98020
Customer: Marie 206-200-4816
PM / Insp: A. Saunsgard 425-495-4465
PHONE NUMBER
VV_QR R l�°t0 t ora tf action Method
Open Trench ❑
Install a 10' scat 1-1/8 stub and a 40'scat extension. Seta 250 meter Trenchless F/I
PLAT MAP, " C A 1 t,_ tW t,6e '7C,,e, .
,..4/ & m
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TkF 224th ST SW
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40' SCAT 1-1/8'° T L
PE EXTENSION
A250 MSA
10' SCAT 1-1/8" V
PE STUB
Work Location
22422
Size of Cut Surface Type
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CL
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_–,-22-4th..ST SW
Work Location
Size of Cut Surface Type
f CL
_–,-22-4th..ST SW
& 'E
f CL ° ..,,,,,.
96th "E.W—
3x5 as halt parking
'N S of CL
_ __..... .._.... _ _
& 'E W of CL..
'NSofCIL
& 'EWofCL_
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..
_ . .
❑✓
FLAGGERS #
2
25 MPH
❑ TROLLY LINES
❑ BUS STOP #
❑ METER HOODS #
❑
OFFICERS #
SPEED LIMIT
❑ TRAFFIC SIGNAL
❑ ARTERIAL
❑ NO PARKS #
❑
Commercial
❑
Altered Commercial
❑ Leak Repair
Service Informatioat
❑ Template Bar
Q
Residential
❑
Altered Residential
❑ CP Work
Diameter
Meter
EFV
El Bollards #
ElMulti-Famiiy
E]
Replacement Service
❑ Pothole
E]5/8"
❑� 250
❑
1800
"
El Bollards 4 4" #
❑
New Constr.
E]
Main Maintenance
❑ Extension
❑ 11/8"
❑ 425
❑Q
2600
Stub
❑
Service Maintenance
❑ 11/4"
❑ 630
❑
10,000 ❑ FUEL LINE PERMIT NEEDED
R
Extension
❑
valve Maintenance
❑ 2"
❑ 1000
Fuel Line Length:
❑
Compete Sery
❑
Cut & Cap
iMtr Loc:
Or
Fuel Line Diameter: