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ENG20170129-APPLICATION.pdf0 1111 iiiiim FED APR 1 9 2017 DEVELOW N'T �C ROW PERMIT NO.: ENG a ©1 — 01 ISSUE DATE: RIGHT-OF-WAY CONSTRUCTION PERMIT APPLICATION PROJECT NAME: MDU JT# 218452 CONTRACTOR: Horizon Communications Inc. s. Mailing Address: .� �.,,m_n.........m____...m..m.._._.�..__ 6501 212th ST SW Lvnnwood. WA 98036 � ... State License #: HORIZCI006DS CityBusinessLicense #: TBD CONTACT: Holly Munyan Phone #: 425-361-7802 Fax #: 425-582-2926 Email #: hmunyan@horizonnw.net Liability Insurance � Bonded ADDRESS OR INTERSECTION OF CONSTRUCTION: 7232 212th ST SW, Edmonds ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT: El Commercial mm l Subdivision [_ City Project ❑ Traffic Control (Only) ® Multi -Family ❑ Single Family Other XI EUC (PUD, VERIZON, PSE, COMCAST, OVWSD): Is this permit part of a blanket permit? ❑ Yes ❑X No ANY ASSOCIATED PERMITS? BLD# ENG# DESCRIPTION OF PROPOSED WORK (Be Specific) : _„ Directional drill (1) 2" conduit 95' from existing pole to private property, set ped. .a. ED WITHIN THE ST FIVE ( LA5) YEARS? YES O E] NYear: .....WA.S...S.TRE.E.T....OVERLAY.....��...��_.....��.. _,. _ .�...._.� PAVEMENT CUT: 0 Yes ® No If yes, indicate size of cut: x CONCRETE CUT: Yes ® No If yes, indicate size of cut: x APPLICANT TO READ AND SIGN R�Mwm *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. 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