ENG20170104-Application.pdfOV- ED&IC),
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PROJECT NAME: 106319531
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: 1NFRASL871C2
City Business License #: NR -023614
ROW PERMIT NO.: ENG
ISSUE DATE:
A,
A
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email 4: Susan.Sidick@pse.com
F-1 Liability Insurance [:1 Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 8711 218 ST SW
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
R Commercial El Subdivision El City Project Ll Traffic Control (Only)
F] Multi -Family FX Single Family n Other
F] 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) : Work area is approx 13's & 2'& 15'N C/l of 218/th
ST SW & 54'E c/l of 87th PL W to install gas service 1 3x5 asphalt, 1 2x7 Asphalt / soft surface, & 1 2x4
private property cuts anticipated.
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YESE] NOE] Year: 1066
PAVEMENT CUT: X Yes F] No If yes, indicate size of cut: -3 x 5
CONCRETE CUT: F] Yes n 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 SIdICkwo-°a-B=US-s° `°� DATE 03/27/2017
o. 2016093001:5130-0l
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
JOB #:
DATE:
JURISDICTION:
ROW PERMIT:
START DATE:
DURATION:
Tim
106319531
3/14/17
Edmonds
Q YES ❑ NO
M
PRE -INSPECTION REPORT VIA" f Nll,k Y
ADDRESS:
8711 214th St Sw
i
CITY/ZIP:
Edmonds 98026
Ext: 42'
CUSTOMER:
PM:1'M
Select Homes (Contact Gary)
c.a U
206-730-01670
Jordan McLean
PHONE NUMB); K
425-563-3703
INSTALL METHOD
Front ittcrin, install app�o:x. 72' of 1-1/8" PE scxrtiplcrt svc., artd set an A425 ureter•, (-'ustorner provided condOpen Trench.uit. New Construct
PLAT MAP: I 164.068 ..............................................................................t.c......................... .......................... ...........................
;
f
8711
MSA
NOTE:
i
Stub: 30'
JA425
Ext: 42'
Surface Type
Power, CTV, Fiber,
f CL 218i1LSMSW
all OH.
_ A7th_P_L W _
No Curb/gutter
PIL
No sidwalk'
m-
_ ZI t11.5 _
ROW = 50' Wide
------- 8_7th_PI W
PAV = 18' Wide
1-1/8" PE l:
*Hydrant H13 -7B is
I I
146ft East of tie-in*
fl
_ _ 87th PI,AV__
f,
If
Private Prop.
1"
f"
f
FLAGGERS #
51RM 12" PVC
Fnp
®............................................................... )tRQ 6' P.1..............
.. ...
........................';.®...................................................................,..................................., ...................SWRS Conc.
-C-/L- -- >.. _...., .. ., .---__ ----.......-,.. _,__--------•----------CfL-
If 1
...................................................................................................................... 7............................................................................ ST.8N112 °..P.u�..........
--- =— ----------------E42--- ' ------
- — — — — 2" PE IP 13'S 9800915
WORK LOCATION
Size of Cut
Surface Type
S
f CL 218i1LSMSW
& 54 W of CL
_ A7th_P_L W _
3x5
Asphalt
S of CL
m-
_ ZI t11.5 _
-'L
&-54- 'E W of CL
------- 8_7th_PI W
2x7
Asphalt/Soft
_
L5 ZS of CL
21$11aa`iT�SW
&_54- 'E W of CL
_ _ 87th PI,AV__
2x4
Private Prop.
❑
FLAGGERS #
MPH ❑
TROLLY LINES
❑ BUS STOP #
❑
METER HOODS #
❑
OFFICERS #
SPEED UM4T ❑
TRAFFIC SIGNAL
❑ ARTERIAL
❑
NO PARKS #
❑
Commercial
❑
Altered Commercial ❑
Leak Repair Service Information
Template Bar
Residential❑
❑
Altered Residential ❑
CP Work Diameter
Meter EFV Pressure
❑
Bollards 2.5" #
F1MUlti-Family
❑
Replacement Service ❑
❑ 5/8
Pothole "
❑ 250 ❑ 1800 �
6�� WC
❑
Bollards 4" #
Q
New Constr.
❑
Main Maintenance ❑
Extension ❑✓ 1-1/8"
Q 425 Q 2600 ❑
2#
❑
Stub
❑
Service Maintenance
❑ 1-1/4"
❑
630 ❑ 10,000 ❑
5# ❑ FUEL
LINE PERMIT NEEDED
❑
Extension
❑
Valve Maintenance
❑ 2"
❑
1000 ❑ 775
Fuel Line
Length:
❑compete
p Sery
❑
Cut & Ca p Meter Loc:
OR 08
D3000
Fuel Line Diameter:
-M-
00
Co
a
18 18 m
bl4 �
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 54' ECL of 87th PI W & 13' SCL of
218th St SW.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
218th St SW
alp
8711
IN
VL-OZM
LEGEND
28* TRAFFIC CONE
® BORE PIT
TRAFFIC FLOW
FLAGGER
WORK VEHICLE
SIGN LOCATION
�m WARNING FLAG
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 54' ECL of 87th PI W & 2'& 13' NCL of
218th St SW,
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
y i co
18 18 8711
V u
218th St SW
GI- __
�g dL-OZML
s
�aC. �o
ell
0 100' iwtt 100'
----------------
LEGEND
ti' fi 28" TRAFFIC CONE
o
> BORE PIT
TRAFFIC FLOW
FLAGGER
�1 WORK VEHICLE
SIGN LOCATION
WARNING FLAG
I
8711 218TH ST SW EDMONDS
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