ENG20170120-APPLICATION.pdfOV E VA,t0
PROJECT NAME: 106322787
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871 C2
City Business License #: N R-023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 24014 79 PL W
ROW WORD ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT: �
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ® Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes W No
ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 163' S C/1 of 240th ST SW
and 15' E & 7' W C/I of 79th PL W to install gas service 1 3x5 concrete cut anticipated and 1 2x4 paving cut anticipated.
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year: 106
PAVEMENT CUT: ® Yes ❑ No If yes, indicate size of cut: 2 x 4
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: 3 x 5
RIGHT-OF-WAY DURATION
AREA TOTAL
CLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF SF
Alley 72 Hrs + LF XLF 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 SidickP.
_5=5's�`°�
Date: 2016 09.30
Contractor or Agent
DATE 04/11/2017
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Haddox, Barbara
From: Angie Wills <Angie.Wills@aaasphalting.com>
Sent: Thursday, April 06, 2017 9:53 AM
To: Haddox, Barbara
Subject: Permits needing updated
106313952
16-rowd-0061
14102 197th Ave SE, Monroe
Expired 12/8/16
106313949
16-rowd-0061
14138 197th Ave SE, Monroe
Expired 12/8/16
106316491
16-rowd-0074
17351 beaton Rd, Monroe
Expired 3/16/17
108594419
16-rowd-0073
212 Powell st, Monroe
Expired 3/16/17
106318778
17-rowd-0003
521 circle Dr, Monroe
Expired 4/5/17
109098632
16-rowd-0075
1408 w main St, Monroe
Expired 3/16/17
That should be all of them
:( Sorry and thank you
Sent from my Verizon 4G LTE Droid
Job #: 106322787
Date: 3/27/17
Jurisdiction: Edmonds
Right of Way Permit? R] YES ❑ NO
Est. Start Date
Est. Duration:
05/29/17
8 Hours
PRE -INSPECTION REPORT * "'b t rr 9',kc-kLY
Address: 24014 79TH PL W
City / Zip: EDMONDS 98026
Customer: Steve Misczuk 704-615-9339
c"syP
PM / Insp: Kiara Hays 425-21379m2rdg
PHONE NUMBER
Construction Method
WORK DESCRIPTION:
IN5 TALL 40'OF 1-118"PE 5CA T STUB
AAID 35'OF 1-118" PE SCA T EXT SET
A425MSA
Open Trench E]
Trenchless
0/)Q.
PLAT MAP:
240TH Si SW
N
Q= FIRE HYDRANT 122' FROM TIE IN
CL
=STORM DRAIN
= SMALL SHRUB GARDEN
CONCRETE PATCH
W
PL
S
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4,
ti PL
0 000""
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Work Location
Size of Cut
Surface Type
❑❑____.
�of
3X5
CONCRETE
ASPHALT
�CLU
163 S f CL of C!
_24ftIH_SI�SW__ &--Z— of CL ____MHR��
'N S of CL
'E W of CL __,_ ------
❑ FLAGGERS # MPH
❑
TROLLY LINES [:1 BUS STOP #
❑ METER HOODS #
❑ OFFICERS # SPEED LIMIT
❑
TRAFFIC SIGNAL Ej ARTERIAL
E] NO PARKS #
❑ commercial n Altered Commercial
F]
Leak Repair Service Information
El Template Bar
Residential n Altered Residential
n
CP Work Diameter Meter
EFV [] Bollards 2.5" #
❑ Multi -Family ❑ Replacement Service
F]
Pothole F] 5/8" ❑ 250
❑ 1800 E] Bollards4"#
E] New Constr. ❑ Main Maintenance
E]
Extension FZ] 11/8" ❑ 425
2600
P] Stub E] service maintenance
E] 11/4" E] 630
F] 10,000 F] FUEL LINE PERMIT NEEDED
Extension [:] valve maintenance
El 2" E) 1000
Fuel Line Length:
❑ Compete Sery E] Cut & Cap
Mtr Loc: 0/111
Fuel Line Diameter:
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 15' E & 7' WCL of 79th PI W
& approximately 163' SCL of 240th St SW.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
240TH ST SW
SET
SOUND
ENERGY
Job#106322787
24014 79th PI W Edmonds, WA
April 10, 2017
Sheet 1 of 1 stephen.gadke@pse.com
(425) 424-6431
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80
35/45 30 60
25/30 20 40
=,> TRAFFIC FLOW
FLAGGER
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
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