ENG20170133-APPLICATION.pdfof EDA.10
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PROJECT NAME: 109102045
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871 C2
City Business License #: NR -023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 9545 Forest Dell Dr
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family X- Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes ® No
ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : Permission is requested to tie into existing 4" pe ip gas main
located at 3' s c/1 of Forest Dell Rd & 9' E c/I of Olympic Ave. To extend 596'-2' PE Ip replacement main east to the end of cul de sac
Majority of main to be directional drilled some hole hog with tie ins to be open cut. Service replacements to be open cut at the main and hole
hogged to existing meter locations. Long side service to proposed to be hol hogged under asphalt 2x2 potholes over water and other utilities where required.
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES ❑ NO ❑ Year: 10
PAVEMENT CUT: ❑ Yes ❑ No If yes, indicate size of cut: 5 x 3
CONCRETE CUT: ❑ Yes ❑ 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.
SIGNATURE Susan SIdICk ��w.� �� °--us-s"�`��
DATE 04/18/2017
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Date of Request: 04/03/17
Job number
Job address
Project mgr:
PM email:
109102045
9545 Forest Dell Dr
Lisa Griffith
lisa.griffith@pse.com
Estimated job start date:
Estimated job completion date:
Description of work to be performed:
07/17/17
08/02/17
Edmonds Zip: 98020
PM contact #: (425) 406-0121
-MONTS WE
rr • �- •� 1 --'r -i • i- •i 1 i • - •��-f
Pavement cut? FI/ Yes FNo
If yes, Dimensions of Cut: Length Width
How many cuts?
Surface Type
Require trenching? lyes FNo
If yes, Dimensions of trench: Length 5' Width 3'
Method of installation: Open trench/hole hog/Directional drill
Traffic impact:
Road closed
Yes
®✓ No
Lane closed
✓Wes
FNO How Many? I
Shoulder closed
YesNo
Sidewalk closed
FYes
No
Emergency Contact: Dean Latimer
Cell Number: (253) 350-6687
Depth 3'
Direction? East