ENG20170084.pdfSTATUS: ISSUED
CITY OF EDMONDS'
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSTC*
ENG20170084
Permit Number: ENG20170084
Job Address: 22325 76TH AVE W, EDMONDS
C/O Susan att: Sid ick
1660 Park Lane
Burlington, WA 98233
ork area is approx 81'N c/I of 224th ST SW & 1
C/O Susan att Sidick
1660 Park Lane
Burlington, WA 98233'
(425)457-6353
LICENSE #: infrasl871 c2 EXP:
ve W to, investigate and repair
Gxplratlon nate: uy/t zs/LuI /
Location: 22325 76TH AVE W
SIDEWALK: ( 0X0) DURATION IN MONTHS: 0 FEE $0,00 STREET DISRUPTION TRENCH CUT: ( 5 X 5 )
PARKING: ( 0X0) DURATION IN MONTHS: 0 FEE $0„00 YEAR OF OVERLAY: 0 FEE: $0;00
ALLEY 0X0 1 DURATION IN MONTHS: 0 FEE: $0,00
INDEMMTY The Applicant has signed an application which states he/she holds the City ofEdmonds 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 of its departments or employees, including but not limited to the defense ofany legal proceedingsincluding defense costs and
attorney fees by reason ofgranling this permit.
THECONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FORA PERIOD OF ONEYEAR FOLLOWING THEFINAL
INSPECTION AND ACCEPTANCE 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 ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 ,HOUR NOTICERI';(),UIRED'FOR ALL INSPECTION, REQUESTS
A PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: ANI
SPACE PROVIDED;
('%l/l �.dt1,►uL 311
RELEASED BY
ARE PAID. AND
DATE
ay, March 17, 220171
E] FILE COPY F-] INSPECTOR COPY E] 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 stall,
• Conform to approved working drawings and Traffic Control plan.
• 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 7:00am to, 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 avariance 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 ofthis permit. Issuance ofthis 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.
INSPECTIONS
• E -Traffic Control
• E -Engineering Final
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
�5/10 4~M
Zam
RECEIVED
�4 NR 0 8 2017 ROW PERMIT NO.: ENGBUILDING
ISSUE DATE:
RIGHT-OF-WAY CONST UCTION
PERMIT APPLICATION
PROJECT NAME: 887033637
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871 C2
City � �N R-019840
Ci Business License #:
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
❑ Liability Insurance Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 22325 76th AVE W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
„.
SITS Commercial Subdivision City Project Traffic Control (Only)
❑ Multi -Family ❑X Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? W Yes W* No
ANY ASSOCIATED PERMITS?
[BLID#__
DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 81' N C/I of 224th ST SW
& 18'E C/I of 76th AVE W to investigate and repair leak 1 5x5 paving cut anticipated
....(5) YEARS? _ NO Year: 8876
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5) YEARS.? YES
PAVEMENT CUT: ® Yes ❑ No If yes, indicate size of cut: 555 x 5
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
APPLICANT TO READ AND SIGN
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no °i ... �� m�WMAX(rrruw
*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 Sidick°��°�°E$etl°°� ATS3/8/2017
SIGNATURE "" �° e
.... ..... ®ale ZQt6 U� 16696P:90 -0MW'
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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Job #:
NCS 1159 C3 P
Date: Oj--;.S—n
Jurisdiction:
Right of Way Permit? ® YES
Est. Start Date:
Est. Duration:
WORK DESCRIPTION:
PLAT MAP:
❑ NO
PRE -INSPECTION REPORT
2 2-` V1 ST S t,✓
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Address: 7-)L32-6 704h c,,a w
City/ZIP: RCwoh c
Customer:
PM / Insp:
PHONE NUMBER
Construction Method
Open Trench ❑
Trenchless E)
I
'N S of CL _ 8 'E W of CIL
'N S of CL a e , 8���_. 'E W of CL _ ..._ . , .
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Size of Cut Surface Type
SK
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FLAGGERS #i—
30 MPH
❑
TROLLY LINES
❑ BUS STOP it
❑ METER HOODS #
❑
OFFICERS #
SPEED LIMIT
❑
TRAFFIC SIGNAL
❑ ARTERIAL
❑ NO PARKS #
Ej
Commercial
❑
Altered Commercial
Leak Repair
Service Information
❑ Template Bar
❑
Residential
❑
Altered Residential
CP Work
Oiamator
Meter
EFV
❑ Bollards 2.5" #
❑
Multi -Family
❑
Replacement Service
❑
Pothole
❑ 5/8"
❑ 250
❑ 1800
❑ Bollards 4" #
❑
New Constr"
❑
Main Maintenance
El
Extension
L)11/8""
E]425
[] 2600
❑
Stub
❑
Service Maintenance
❑ 11/4"
❑ 630
❑ 10,000 ❑ FUEL LINE PERMIT NEEDED
❑
Extension
❑
valve Maintenance
❑ 2"
❑ 1000
Fuel Line Length:
❑
Compete Sery
❑
Cut & Cap
Mir Loc:
Fuel Line Diameter:
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STREET USE PERMIT REQUEST FORM
Date of Request:
Job number:
Job address:
Project mgr:
PM email:
03/06/17
887033637
22325 76TH AVE W City: Edmonds Zip: 98026
Veronica Paulson PM contact #: (253) 617-6023
veronica.paulson@pse.com
Estimated job start date: 04/10/17
Estimated job completion date: 04/10/17
Description of work to be performed:
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76th Ave W.
Pavement cut? yes F-1No
If yes, Dimensions of Cut: Length 5
How many cuts? one
Surface Type asphalt
Require trenching? ®yes No
If yes, Dimensions of trench: Length,
Method of installation:
Traffic impact:
Road closed Dyes
✓ No
Lane closed
; ✓es
No
Shoulder closed
OYes
M
No
Sidewalk closed
es
El
No
Emergency Contact Mike Blood'
Cell Number: (425) 864-6154
Width 5
Width
Depth
How Many? one Direction? East