ENG20170130-APPLICATION.pdfOf EVA.10
ROW PERMIT NO.: ENG
ISSUE DATE:
PROJECT NAME: 106323082
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 El Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 9821 228th PL SW
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F] Commercial El Subdivision F] City Project [:1 Traffic Control (Only)
F] Multi -Family FX] Single Family F] Other
F EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? F-1 Yes F*_1 No
I ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WOW (Be Specific) : Work area is approx 16'S C/1 of 228th PL SW &
5e�rutc_-_
17'W c/l of 98th AVE W to install gas -m. -4p. 1 2x5 paving cut anticipated.
I WAS STREET OVERLAYED WITHIN THE LAST FIVE, (5) YEARS? YES [] NOE] Year: 106Zi
PAVEMENT CUT: M Yes F-1 No If yes, indicate size of cut: 2 x 5
CONCRETE CUT: El Yes R 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 Sldick P o- s-5tr�`°� DATE 04/18/2017
Dale: 2016 0930 OTS ] 30 -0i W'
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
WORK DESCRIPTION:
PRE -INSPECTION REPORT
Job #:
106323082
Open Trench F�
k' '0�N��,Y
Date:
2/25/17
Address:
9821220thPL5VV
Jurisdiction:
Edmonds
City /Zip:
Edmondo98020
Right ofWay Permit?
2 'ss E] NO
Customer:
Travis 360-420-3699
Est. Start Date:
1137
pKd/|nnp:
A.Baunsgard 425-495-4465 `°°/ pnmwEmvNIac«
46' scat stub
WORK DESCRIPTION:
Construction Method
Open Trench F�
Install 46'scat 1-1/8 stub and 100',5cat 1-1/8 Extension. 5et a 425 tneter. Main is inserted,
CM has approved service route,
Trenchless F�j
X A425 IVISA
1137
46' scat stub
100' scat
T97;
extension
9727
9829
9805
>
<
00
228TH5
SW
5�b' PEI
ya
V4" PE�A IP �6!,
9828
2
9726
9718
72015,
sjl' PEI
VIFEI 74S
9820
511, N1,PEI
9806
71
Work Location
Size
of Cut
Surface Type
76S
FLAGGERS # 25 MPH TROLLY LINES BUS STOP #
F1 METER HOODS #
OFFICERS # SPEED LIMIT Ej TRAFFIC SIGNAL ARTERIAL
0 NO PARKS #
commercial Altered Commercial E] Leak Repair Service Information
El Template Bar
Residential E] Altered Residential Fj CP Work
Diameter Meter
EFV
Bollards 2.5" #
Multi -Family D Replacement Service El Pothole
[] 5/8" Ej 250
E] 1800
New Constr. E] Main Maintenance F-1 Extension
11/8" 425
M, 2600
Bollards 4" #
F,� Stub El service maintenance
11/4" 630
F] 10,000 n FUEL LINE PERMIT NEEDED
Extension El valve maintenance
F) 2" El 1000
Fuel Line Length:
compete Sery E] Cut & Cap
Mtr Loc:
Fuel Lin e Diameter: