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ENG20170066-Application.pdf,INC. 1591-1 FEBRECEIVED 23 2017 ROW PERMIT NO.: ENG C� BUILDING�ISSUE DATE: RIGHT-OF-WAY CONSTRUCTION PERMIT APPLICATION PROJECT NAME: COMCAST CONTRACTOR: PAQIFI CABLE F Cr)NRTRI Ir..TIO Mailing AddressPo BOX 573 WOODINVILLE WA 98072 State License #:PACIFCC954PJ City Business License #: NR -022340 CONTACT: BREANNA SWIFT Phone #: 425-348-7735 Fax #: 425-348-7966 Email #: BREANNA@RACCAB.COM FXJ Liability Insurance [X] Bonded ADDRESS OR INTERSECTION OF CONSTRUCTION: 21225 SHELL VALLEY RD ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT: Commercial ❑ Subdivision ❑ City Project 0 Traffic Control (Only) ❑ Multi -Family ❑ Single Family F Other l EUC (PUD, VERIZON, PSE, COMCAST, OVWSD): Is this permit part of a blanket permit? ❑ Yes ® No ANY ASSOCIATED PERMITS? BLD# ___ ENG# DESCRIPTION OF PROPOSED WORK (Be Specific) : INSTALL CATV SERVICE LINE. BORE A TOTAL OF 48FT IN THE ROW. 24FT SOFT SURFACE, 24FT HARD SURFACE CROSSING SHELL VALLEY RD WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES 0 NO Year .......... PAVEMENT CUT: [j] Yes ❑ No If yes, indicate size of cut: 2 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 LXLF LF SF Parking 72 Hrs + 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 ice' DATE Con actor or Agent 2-23-2017 NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE COMM. �CSG tocat�a 1� � 5�� CSG DI op Ruryll Date Z r 0 /1 Node -mi— ► Bury Drop Farm Customer Name: Pa U v �Lle%! 1 :i n Phonelf W, f- 7733 900.775 Address:,y t ? 7 e; CA}a r (. A& -j CY JC -ICILY: I• •Mn,nr,-N Ir�S Zip: 9�(i?f., Cross Street; ❑Service E ff�e�ctrop ❑m Ou�t. of Serv, Ice ❑PendlngInstall ❑M Teaped T,ecqh#90V? Pi lority Leve! ❑1 Commercial [12 -New Cust /Svc Drop Impaired /Can't Temp []3 -Svc DI op Irri aaired / Can Temp g ROW Footage Permit ftequlred Y NJ 'Back Yai'd Easement Y f" 1 vee of Bury STH Foota e 'Sidewalk: a V. a.NSe Septic Field: Sidewalk Bore I i, t,l r til Y N Sprinkler Inkier S stem Y N Arlveway Rore p andscaue Bore Road CdRe Y� N Drain Pipe V N o�aaa d Road Bore �} ° Ctn b Y N�] Private Watm Y� � Soft surface 2c{ Hard Surface Total _2W ` Private Wiring. YE] NZ . Total c� Total qe)jTotal Bury What Kind? �an..nu�a� ons}aaeiL� er First V© N❑ Best li For Customer ( A45 Customer Home F'ni [3urv' Y N � Cali Custom CUSTOMER CONTACTED AND REVIEWED ROUTING OF NEW DROP YL_J NOT HOME, LEFT DOOR TAG Y j Being the owner of the above property, I hereby give my permission to Comcast, or their duly authorized representative to bury a service line on my property. Property Owner's Signature: , tG Oa nrcmm M Exlsti W ns Csrson _ Pole. .... Phoria treat Light _ idol ... _.... Power Catch Basin Frontier Fire Fl Ydrant �, , Water/Irrigation Mull 6ax Gas- .,.�.' . �aow S lei i irrrw fio Cct}hr SI 10 , k,1'e c1 rit Hifi ws W tslr � r r' Via t e} cl , ra-LY(et s [I"91 Il1yTIM P<rin, P tv I ca3p}t T 1'1'LY1S . } 6�(I"�ACTOTY� 111-i�64 L3CCTYAr I (%dY c �5`"S t LS Tj� JLC _ w. PEI f..At 1��fl tlw. �... .:7ti ..roflll ._.., `...I wm�%,gllum bVVICA I 11"Im"ll f"I"I'll"IR 111,10 11*11r", I'll I I I" I I I d f)'� I L WORK WM L- ffi SHOULDER CLOSURE -LOW SPEED (40 MPH OR LESS) 1140T W SCALE r I.AIRC C.1011.1. N.A.