ENG20170113-APPLICATION.pdfof EDA,10
ZA�C- 9 0
. IS,
ROW PERMIT NO.: ENG
ISSUE DATE:
PROJECT NAME: 109104181
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871C2
City Business License #: N R-023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
F-1 Liability Insurance [:] Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 801 12th PL N
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F-1 Commercial El Subdivision Ej City Project E] Traffic Control (Only)
F] Multi -Family FX]
F-1 Other
F-1 EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? El Yes No
I ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WOR1--'- (Be Specific) : Work area is approx 80'N C/I of Cascade Dr
IFS to replace service to above address 2 hard surface cuts 3x5 & 2x4 anticipated.
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES 0 NO E] Year: 10
PAVEMENT CUT: X1 Yes F-1 No If yes, indicate size of cut: 3 x 5
CONCRETE CUT: R Yes R No If yes, indicate size of cut: x
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
*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 4/7/2017
SIGNATURE D-' 2016,W.W 07,57,30 OTW' DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
r4o mooq
QM�PRE -INSPECTION REPORT
" b 4 4 14) D,
Date: *6 - Z-1 - 1,7 Address: !!To I - t ?- P r4
Jurisdiction: e'd V -too C1 S City / Zip: E -601,0,4C11 -
Right of Way Permit? 2"'YES 0 NO Customer:
--Er
Est. Start Date: PM/lnsp: tLa-CU5TPHUi
cd,30 -uE-t4U I&qr-
Est. Duration:T_G"�t%4 PHONE NUMBER
WORK DESCRIPTION: Vaf2locr- V /,to S-rw (..eAr_dt C40 tjaooq I
Construction Method
Open Trench ❑
I tan 1/6 W 11000 AAr-,7T_0_
Trenchless
PLAT MAP:
P;z
C.
P
5o' P-ot-
r
V1
10
_V
16TO R -M 1,j
\uo
Work Location
Size of Cut Surface 1M
f CL -L ,k s �r-•
of CIL W ft-
r-3 3*r-S, ?AVb1"S3
3L
Df CIL
SN S of CL
& 'E W of CL
RIFLAGGERS # Z_ V5 MPH Ej
TROLLY LINES
0 BUS STOP # ❑ METER HOODS #
0 OFFICERS # SPEED LUT 0
TRAFFIC SIGNAL
El ARTERIAL ❑ NO PARKS #
171 Commercial 0 Altered Commercial M'Leak
Repair
Service Information [I Template Bar
0 Residential El tered Residential El
E] Multi VReplacement
CP Work
Otameter
El 518-
Meter EFV
0 250 0 18no Bollards 2.5" #
-Family Service E)
Pothole
El New Constr. [I Main Maintenance 0
Extension
0 11/8"
El 425 � 2600 Bollards 4"#
E-) Stub 0 Service Maintenance
[1 11/4"
F1 630 [1 10,000 [1 FUEL LINE PERMIT NEEDED
0 Extension 171 Valve Maintenance
[1 2"
B"1000 Fuel Line Length:
El Compete Sery El cut & cap
Mtr Loc:
0 tA Fuel Line Diameter.
LEGEND
� 28'TpAFFIC CONE
BORE PIT
=�TRAFFIC FLOW
rL^ou cn
vmnxmvu/e
SIGN LOCATION
WARNING FLAG
''— ------
Cascade Dr
100,
10?011�w
Notes:
<11
1.All signs and spacing Nconform tothe MUTCO
and City ofEdmonds standards.
2.All sidewalks, driveways, exits and egresses shall bo
completely clear unless otherwise indicated.
3.Channe|izinQdevices are 2V''traffic cones.
4.Sign size can boaminimum of48^x4D"and shall not
obstruct pedestrian access.
5.Crew iorequired (nleave mminimum nf11'for traveling
lanexid&
6.Alert affected residents and businesses.
T.Work hotake place between Qa.m.and 4p,m.
8.Work area will ba15'ECLo(12th P|N&8O'NCLo[
Cascade Dr.
9.|fused, place NO -PARK signs 72hours inadvance
u/the day that the work iahobedone.
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55f7O 40 80
35/45 30 60
25/30 20 40
VL-OZM I. -OM
Q EK
100,
10?011�w
�
LEGEND
TANGENT
28* TRAFFIC CONE
80
BORE PIT
1, All signs and spacing to conform to the MUTCD
TRAFFIC FLOW
and City of Edmonds standards.
FLAGGER
2. All sidewalks, driveways, exits and egresses shall be
WORKVEHICLE
completely clear unless otherwise indicated.
SIGN LOCATION
3. Channelizing devices are 28" traffic cones.
WARNING FLAG
�
MPH TAPER
TANGENT
s5nQ 40
80
35/45 30
1, All signs and spacing to conform to the MUTCD
25/30 20
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.
GAlert affected residents andbusinassns.
7.Work k/take place between 8a.m.and 4p.m.
D.Work area will be|5'VVOLo[12thP|N&O0'NCLo[
Cascade Dr.
9.|fused, place NO -PARK signs 72hours inadvance
oythe day that the work in\obndone.
CHANNELIZATION
DEVICE SPACING
MPH TAPER
TANGENT
s5nQ 40
80
35/45 30
60
25/30 20
40
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