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PROJECT NAME: 106321664
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871C2
City Business License #: N R-023614
ROW PERMIT NO.: ENG
ISSUE DATE:
X
Phone #: 425-457-6353
Fax #:
Email 11: Susan.Sidick@pse.com
F-1 Liability Insurance F-1 Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 20304 87 AVE W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F-1 Commercial El Subdivision Ej City Project E] Traffic Control (Only)
F-1 Multi -Family FRI Single Family F] Other
F EUC (PUD, VERIZON, PSE,
CONICAST, OVWSD):
Is this permit part of a blanket permit? F-1 Yes No
I ANY ASSOCIATED PERMITS? BLD# ENG# I
DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 420'S C/l of 202nd ST SW & 13'
E & 4'W c/l of 87th AVE W. To install gas service I 3x5 soft surface cut & 1 2x4 asphalt cut anticipated.
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YESE] NOE] Year: 106h
PAVEMENT CUT: X1 Yes F] No If Yes, indicate size of cut: 2 x 4
CONCRETE CUT: n Yes F1 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 + 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 Sidick P�,4bsan 3/27/2017
UN: m=Susan Slidtl�, o=Puget Sound E� ' ou=Street Use
SIGNATURE Pe�g,ema= �,a�Pe�,"°5 DATE
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Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Job#
Jurisdiction: Edmonds
Right of Way Permit? 0 YES NO
Est. Start Date: 05/15/17
Est. Duration: 8Hourm
Address:
City /Zip:
Cuahomec CYNTHZNAkAAPKEK 425'582-1981
PK4/|nap: k]oroHoyo M-F13'92OS
PHONE NUMBER
WORK DESCRIPTION:
Construction Method
Open Trench
IN5TALL 45' OF 1-118".PE5CA T 5 TUR AND 30' OF 1-1/8" PE SCA TEXT 5ETA250 OIL
Trenchless
WCL S
202ND ST SW
G
Fire Hydrant (70'from tie in)
Sewer Manhole
Tree
N
PIL
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W CL
Work Location
Size of Cut
Surface Type
Of
--- 1=lD_S_T_SW_ E f L __.____a7TH_.AVEJN_
SOFT SURFACE
3X6
'a—f-CL
Lof C__
FLAGGERS # MPH TROLLY LINES [j BUS STOP # METER HOODS #
F-1 OFFICERS # SPEED LIMIT TRAFFIC SIGNAL [:] ARTERIAL NO PARKS #
commercial Altered Commercial E] Leak Repair Service Information El Template Bar
Residential Altered Residential CP Work Diameter Meter EFV Bollards 2.5" #
Multi -Family Replacement Service Pothole 5/8" 250 1800 Bollards 4" #
E] New Constr. Main Maintenance Extension 11/8" 425 2600
n, Stub service maintenance 11/4" 630 10,000 [:] FUEL LINE PERMIT NEEDED
Extension El valve maintenance 2" 1000 Fuel Line Length:
compete sery F-1 Cut & Cap Mtr Loc: O/L Fuel Line Diameter:
OV3HV
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RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80
35/45 30 60
25/30 20 40
202ND ST SW
0
Notes:
1. All signs and spacing to conform to the MUTCD
and City of Edmonds standards.
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2. All sidewalks, driveways, exits and egresses shall be
a completely clear unless otherwise indicated.
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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 6
6. Alert affected residents and businesses.
7. Work to take place between 9 a.m. and 4 p.m.
8. Work area will be 13' ECL & 4' WCL of 87th AV W &
approximately 420' SCL of 202nd St SW.
9. If used, place NO -PARK signs 72 hours in advance
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_ of the day that the work is to be done.
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28" TRAFFIC CONE
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