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ENG20170075.pdfSTATUS: ISSUED u'IT „ OF EDMONDS 121 5TH A'VENUENORTH - EDMONDS, WA 98020 PHONE: (425) 771-0220 - FAX: (425) 771-0221' *PERMIT MUST BE POSTED ON JOBS TE* ENG20170075 Permit Number: ENG20170075 Expiration' Date: 09/08/2017 Job Address: 8711200TH ST SW, EDMONDS Location: 8711 200TH ST SW APPLICANT CONTRACTOR PSOInfrasource PSE/Infrasource GO Susan att: Sid ick C/o Susan act: Sidick 1660 Park Lane 1660 Park Lane Burlington, WA 98233 Burlington, WA 98233 (425)457-6353 LICENSE #`. infrasl87Ic2 EXP: 02/22/2019' Work area is approx 16' S c/I of 200th ST SW & 258' E c/I of 88th Ave W also 15'n c/I of 200th St SW & 258' W c/1 of 88th Ave install gas service 1 3x5 paving cut anticipated and 1 2x4 asphalt soft surface cut anticipated! ASSESSED VALUE: $0,00 PROPERTY AREA: 0 SIDEWALK: ('0X0') DURATION IN MONTHS: 0` FEE $0,00` STREET DISRUPTION TRENCH CUT: (•3 X 5 ) PARKING: (OXO) DURATION IN MONTHS: 0 FEE: $0,00 YEAR OF OVERLAY: 0 FEE: $0,;00 ALLEY; ( OXO' DURATION IN MONTHS: 0 FEE $0,00 INDEMNITY The Applicant has signed an application ivhich stales he/she holds the City'ofEdmonds harmless from injuries, damages or claims ofany kind or description Ivhatsoeher, foreseen or unforeseen,` that maybe made against the City of Edmonds or any of its 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 OF THE W ORK. • 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 ANY EXCAVATION CALL FOR INSPECTION (425) 771-0220 EXT.1326 24 HOUR NOTICER UIRED FOR ALL INSPECTION REQUESTS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HEI SPACE PROVIDED UTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN Printed: Wednesday, March 08; 20121 ❑ FILE COPY F-] INSPECTOR COPY ❑ APPLICANT COPY r 1 1 8 RECEIVED MAR 01 017 BUILDINGROW PERMIT NO.: ENG ISSUE DATE: RIGHT-OF-WAY CONSTRUCTION PERMIT APPLICATION PROJECT NAME: 106319716 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.Sidick@pse.com Liability Insurance Bonded ADDRESS OR INTERSECTION OF CONSTRUCTION: 8711 200th ST SW ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT: Commercial El Subdivision City Project Traffic Control (Only) ❑ Multi -Family N Single Family ❑ Other ❑ EUC (PUD, VERIZON, PSE, COMCAST, OVWSD): Is this permit part of a blanket permit? ❑ Yes © No A�YASSOCIATED:):PE:�R�NHTS? I BLD#_ ... ENG# mmmm� DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 16'S c/1 of 200th ST SW & 258' E C/I of 88th AVE W also 15'N C/I of 200th ST SW & 258'W C/I of 88th AVE W to install gas service 1 3x5 paving cut anticipated and 1 2x4 asphalt/ soft surface cut anticipated. WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES ❑ NO PAVEMENT CUT: N Yes ❑ No If yes, indicate size of cut: 3 X 5 CONCRETE CUT: 0 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 SF ......_ Alley 72 Hrs + ._.....................�L......._.... ._. F X LF SF Parking 72 Hrs + LF X LF SF APPLICANT TO READ AND SIGN ���ma�rairRrrrrmmrar�rmmam�m�m��rc mmmmmim�i�immmmmmmm�wi i _..�� a�rommrt�r�r��artmi�rc�������m������� �wmmumim *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 SIdICi( °m � " �'u y� e=s�"�°� DATE �w��n� P��� 3/1/2017 Contractor or Agent NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE E A C Ln < S pN 13 Wo am E C) E>L) 2 LLU 2 w" > 3� Z ts c'D U) (D Q3 M C3- (f) LL o Ia R) -.n aj co (u :31 o8 0 Eo E - E c cm u Lu 'u, 2 > z 03 2 j E 2 :2 m W20-1we 0 3- 2 w to ca L) K�' u m 7) L) o cL < < E E) A LLIz m ci ou C; 4 o Ui cn !2 (6 r� 06 .6 oi wo F- C",� j Z1, , — W, 9 "-3 , L.n 3 W o !2 2E o w 1� A I IV'> , � T O z to �2 6 1 W W C3 o ac o o 5wo 6Q. r. I,-OFM 88THAVE W z 2 S z M cL9 7 z I O�u MO W tn LEI !1 8- c g L+`� (Cp N N > U o v ca •� w a) c bo o � a) v r C C ie ' CZ -5 N C E m =v = a ti 0 N ` O N C N E L J 01 U N O N d 7 C U N w0 V N 10 "U N' 0.; C N (0 r w �, /1 �U) U N N U 3 y CO 7 L d l6 N N o N EY N C C•.c-. ` O •rJ �p N 7 y 3 (V ZN U W W t0 U 'N N t0 O O. at.J a y L '� J T c 'a m U .�`y Yz N N _U— aL m2 N 3� U- 7 07 zr l0N U 07 4 O (O l'0600 O) o 88TH AVE W C"^ z �R q wZ M 3 to - Woo q tl C)zZ0m'ov cn CL (A 5) LL 0 F L o... 0 N (O c CA7 II $m o Z q cD N tl r g r 1 N J mZ q g� U w¢0 a w D q t c g L+`� (Cp N N > U o v ca •� w a) c bo o � a) v r C C ie ' CZ -5 N C E m =v = a ti 0 N ` O N C N E L J 01 U N O N d 7 C U N w0 V N 10 "U N' 0.; C N (0 r w �, /1 �U) U N N U 3 y CO 7 L d l6 N N o N EY N C C•.c-. ` O •rJ �p N 7 y 3 (V ZN U W W t0 U 'N N t0 O O. at.J a y L '� J T c 'a m U .�`y Yz N N _U— aL m2 N 3� U- 7 07 zr l0N U 07 4 O (O l'0600 O) o 88TH AVE W C"^ z �R q 'uW20-1 q tl C)zZ0m'ov q z o... p CA7 II wZ W z Uwo3ZUo�',n]C4, Q. V tl c g L+`� (Cp N N > U o v ca •� w a) c bo o � a) v r C C ie ' CZ -5 N C E m =v = a ti 0 N ` O N C N E L J 01 U N O N d 7 C U N w0 V N 10 "U N' 0.; C N (0 r w �, /1 �U) U N N U 3 y CO 7 L d l6 N N o N EY N C C•.c-. ` O •rJ �p N 7 y 3 (V ZN U W W t0 U 'N N t0 O O. at.J a y L '� J T c 'a m U .�`y Yz N N _U— aL m2 N 3� U- 7 07 zr l0N U 07 4 O (O l'0600 O) o 88TH AVE W C"^ z w .�.. C)zZ0m'ov z o... 2 a U > O _Z w o wZ W z Uwo3ZUo�',n]C4, Q. V Open Trench Ope From main, install approx. 90' of 1-118" PE scat sm., and set an A250 meter. Okay to cul driveway as needed. New Construct PINI'MAP: 162.068 11 ,.. ...... ............ ..... .....„ 9 i 0 u -utak`-tA t- b' q "I J' ` 5711 i NOTE: Stub: 33' Ext: 50' Power, CTV, Fiber, all OH. 6r?N. � ", � P(L Curb/gutter. Asphalt sidewalk on South side. ROW = 50' Wide f. PAV = 21' Wide STRM ,,........................... . .. 57I�m- - Lt���� ---- PRE -INSPECTION REPORT JOB 4: 106319716 Size of Cut Surface Type DATE: 2/17/17 ADDRESS: 9711 200t1i ST SW _ .m m. $$tli��ixe.�3 JURISDICTION: Edmonds CITY/ZIP: Edmonds 98026 ROW PERMIT: ❑� YES ❑ NO CUSTOMER: Robin Hartley W.ee c , •: 206-915-3885 START DATE: 03/27/17 PM : Jordan McLean rmv" ery 425-563-37 -3703 DURATION: 1.5 C4 ❑✓ FLAGGERS # 2 35 MPH WORKDESCRJrTION: TROLLY LINES ❑ BUS STOP # INSTALL METHOD Open Trench Ope From main, install approx. 90' of 1-118" PE scat sm., and set an A250 meter. Okay to cul driveway as needed. New Construct PINI'MAP: 162.068 11 ,.. ...... ............ ..... .....„ 9 i 0 u -utak`-tA t- b' q "I J' ` 5711 i NOTE: Stub: 33' Ext: 50' Power, CTV, Fiber, all OH. 6r?N. � ", � P(L Curb/gutter. Asphalt sidewalk on South side. ROW = 50' Wide f. PAV = 21' Wide STRM ,,........................... . .. 57I�m- - Lt���� ---- WORK LOCATION Size of Cut Surface Type " S )f CL _ _ 21aOt1L.�S.t av _...._ & 258 'E W of CL _ .m m. $$tli��ixe.�3 3x5 Asphalt . S Of CL 8 '1C W of CL 8_th_A�Ye W . .___ .�2x4� Asphalt/Sof W.ee 'N S of CL w & 'E W of CL ❑✓ FLAGGERS # 2 35 MPH ❑ TROLLY LINES ❑ BUS STOP # ❑ METER HOODS # ❑ OFFICERS # SPEED LIMIT ❑ TRAFFIC SIGNAL 0 ARTERIAL ❑ NO PARKS # Commercial ❑ Altered Commercial ❑ Leak Repair Service Information ❑ Template Bar ❑ Residential ❑ Altered Residential ❑ CP Work Diameter Meter EFV Pressure ❑ Bollards 2.5" # Multi Family ❑ Replacement Service ❑ Pothole �_� 5/8" ❑� 250 ❑ 1800 Q 6" WC ❑ Bollards 4" # New Constr. ❑ Main Maintenance ❑ Extension ❑ 1-1/8" ❑ 425 ❑✓ 2600 ❑ 2# ❑ Stuh ❑ Service Maintenance ❑ 1-1/4" ❑ 630 ❑ 10,000 ❑ 25N ❑ FUEL LINE PERMIT NEEDED Extension ❑ Valve Maintenance ❑ 2" ❑ 1000 ❑ 775 Fuel Line Length: ❑ Compete Sery ❑ Cut & Cap I Meter Loc: OR IHS I Fuel Line Diameter: