ENG20170164-APPLICATION.pdf01: EVA,104�
ROW PERMIT NO.: ENG
ISSUE DATE:
PROJECT NAME: 106323705
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: 1NFRASL871C2
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: 17707 Talbot Rd
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family Z 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) : Work area is approx 190' N C/l of
178th ST SW & 18'E c/l of Talbot Rd. To install gas service 1 3x5 cut in gravel anticipated.
I WAS STREET OVERLAYED WITHIN THE LAST FIVE, (5) YEARS? YESE] NOE] Year: 106jj
PAVEMENT CUT: Z Yes Z No If yes, indicate size of cut: 3 x 5 gravel
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
RIGHT-OF-WAY DURATION
AREA TOTqSF
CLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF
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.
D:9.Rwsg Wby Susan SAc
SIGNATURE
Susan Sidick °� s�5 =5"� DATE 4/21/2017
D.. 2016.09.30 07:5 ] 30 -07
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Date of Request: 04/20/17
Job number:
Job address
Project mgr
PM email:
106323705
17707 TALBOT RD City: Edmonds Zip: 98026
Kiara Hays
kiara.hays@pse.com
Estimated job start date:
Estimated job completion date:
06/12/17
06/16/17
PM contact #: (425) 213-9205
Description of work to be performed:
INSTAI I -5)0'0E 1-1/8"PE S_CAI STI AND 210' OF 1-1/8" PE,SGAT EXLS ET42--5
MSA O/R. DO NOT CUT PAVEMENT IN ROW.
Pavement cut? FYes ✓ No
If yes, Dimensions of Cut: Length Width
How many cuts?
Surface Type
Require trenching? MYes �No
If yes, Dimensions of trench: Length Width
Method of installation: Hole hog
Traffic impact:
Road closed Yes
✓ No
Lane closed R✓ Yes
No
Shoulder closed Z'es
® No
Sidewalk closed ®Yes
No
Emergency Contact. Dean Latimer
Cell Number: (253) 350-6687
Depth
How Many? 2 alt. Direction? North
Job#: 106323705
Date: 3/29/17 Address: 17707 TALBOT PD
Jurisdiction: Edmonds
Right of Way Permit? El YES NO
Est. Start Date: 08/19/17
Est. Duration: QHuurr
City / Zip: Edmonds98026
Customer: AdrionoClampitt 4252756592
PM/|nop: k]oroHoya 425-213-92O5
PHONE NUMBER
WORK DESCRIPTION:
Construction Method
IA15TALL 50' OF
1-1/8" PE 5CA T STU9 AND 210' OF 1-118" PE 5CA TEXT 5ETA425MSA
Open Trench E]
PLAT MAP:
Pi
CIL
PL
ASPHALT SHARED
DRIVEWAY
NEIGHBOR DRIVEWAY
178TH ST SW
WCL
MANHOLE COVER
=STORM DRAIN
EM = Water Meter box
0 FIRE HYDRANT (84'from tie in)
Work Location
Size of Cut
Surface Type
TH ST SW
& L
GRAVEL
3X5
FLAGGERS #
MPH
F1 TROLLY LINES BUS STOP # [j METER HOODS #
OFFICERS #
SPEED LIMIT
F TRAFFIC SIGNAL ARTERIAL NO PARKS#
F-1 commercial F
Altered Commercial
0 Leak Repair Service Information Template Bar
[D Residential []
Altered Residential
F� CP Work Diameter
Meter EFV Ej Bollards 2.5" #
El Multi -Family E]
Replacement Service
Pothole 0 5/8"
[—] 250 E] 1800 E] Bollards 4" #
Ej New Constr. E]
Main Maintenance
Extension 2 11/8"
r�j 425 Ej 2600
Stub D
service maintenance
(—] 11/4"
[] 630 0 10,000 Ej FUEL LINE PERMIT NEEDED
Extension D
valve maintenance
D 2"
El 1000 Fuel Line Length:
F I compete sery R
Cut & Cap
Mtr Loc:
OIR Fuel Line Diameter:
0
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80
35/45 30 60
25/30 20 40
178TH ST SW
an spacing to conform to the MUTCD
dmonds standards.
ks, driveways, exits and egresses shall be
ear unless otherwise indicated.
ng devices are 28" traffic cones.
an be a minimum of 48" x 48" and shall not
strian access.
req
a
r
DO
0
—I
9
PUGET
SOUND
ENERGY
Job#106323705
17707 Talbot Rd, Edmonds WA
April 20, 2017
Sheet 1 of 1 ryan.honeysett@pse.com
(425) 457-5381
to leave a minimum of 11' for traveling
ed residents and businesses,
ke place between 9 a.m. and 4 p.m.
will be 18' ECL of Talbot Rd & 190' NCL of
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
0
o Q
° o
0
0
B-
ONE LANE p
ROAD CV
CD AHEAD
O
ROAD ;
WORK o
AHEAD N
LEGEND
28" TRAFFIC CONE
®
BORE PIT
TRAFFIC FLOW
rr
FLAGGER
WORK VEHICLE
SIGN LOCATION
O
WARNING FLAG
v
0 O�
OhOHb
�� a
o Notes:
1. All signs a
, and City of E
o
�71 2. All sidewal
p completely cl
00
/ 3. Channelizi
^
4. Sign size c
/ obstruct pede
5. Crew is re
lane width.
/'
0 6. Alert affect
v 7. Work to to
8. Work area
178th ST SW
a
r
DO
0
—I
9
PUGET
SOUND
ENERGY
Job#106323705
17707 Talbot Rd, Edmonds WA
April 20, 2017
Sheet 1 of 1 ryan.honeysett@pse.com
(425) 457-5381
to leave a minimum of 11' for traveling
ed residents and businesses,
ke place between 9 a.m. and 4 p.m.
will be 18' ECL of Talbot Rd & 190' NCL of
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
0
o Q
° o
0
0
B-
ONE LANE p
ROAD CV
CD AHEAD
O
ROAD ;
WORK o
AHEAD N
LEGEND
28" TRAFFIC CONE
®
BORE PIT
TRAFFIC FLOW
rr
FLAGGER
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
6
o10
o"
N
M
N�-
N
10 �P
s h
o
N
n
Ei
O
3,81 dyd z
6
I
Fell
O
-f-
C3
O
00
-00 -0o
•c Ol
.Ude
06
O
O � N
Z<no