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ROW PERMIT NO.: ENG
ISSUE DATE:
PROJECT NAME: 109102458
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: lNFRASL871C2
City Business License #: NR -023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email 1l: Susan. Sidick@pse.com
F-1 Liability Insurance El Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 190th PL SW & Olympic View Dr
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F-1 Commercial El Subdivision F] City Project [:1 Traffic Control (Only)
F-1 Multi -Family X Single Family F] Other
F-1 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) : Install bollards to protect existing facility.
No paving cuts anticipated.
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES El NO El Year: 1096
PAVEMENT CUT: X1 Yes X1 No If Yes, indicate size of cut:
CONCRETE CUT: n Yes F-1 No If yes, indicate size of cut:
0
PRIGHT-OF;-WA;Y DURATION
AREA TOTAL
(NUMBER OF MONTHS)
LF X LF SFey 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 ° �= � �g ��5=s"�`°�
date: 20,609 07,57 30 DATE 4/18/2017
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Date of Request:
Job number:
Job address:
Project mgr:
PM email:
04/18/17
109102458
190th PI SW & Olympic View Dr City: Edmonds Zip: 98020
Shawnte Anderson PM contact #: (425) 691-8653
shawnte.anderson@pse.com
Estimated job start date:
Estimated job completion date:
05/15/17
05/17/17
Description of work to be performed:
Install bollards to protect existing facility
Pavement cut? "i es No
If yes, Dimensions of Cut: Length Width
How many cuts?
Surface Type
Require trenching? "i es FNo .
If yes, Dimensions of trench: Length Width
Method of installation:
Traffic impact:
Road closed E]Yes
No
Lane closed ✓Wes
FNO How Many? 1
Shoulder closed MYes
No
Sidewalk closed Yes
F No
Emergency Contact: Shawnte Anderson
Cell Number: (425) 691-8653
Depth
Direction? East
PUGET
® SOUND
I ENERGY
Job#109102458
190th PI SW & Olympic View Dr Edmonds, WA
April 4, 2017
Sheet 1 of 1 stephen.gadke@pse.com
oI (425) 424-6431
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100' 100' 100' /
CHERRY ST �� � �2 ' ® 190TH PL SW CHANNEUZATION
—
c5 o I/ �— DEVICE SPACING
b a MPH TAPER TANGENT
100' 100' 100' 55/70 40 80
35145 30 60
25130 20 40
p> N Notes:
883? 11'11 ti 1. All signs and spacing to conform to the MUTCD
W20-1 W20 -7A (4 0° and City of Edmonds standards.
4V3-4 N 2. All sidewalks, driveways, exits and egresses shall be
BE
LEGEND b PREPARE completely clear unless otherwise indicated.
® N To 3. Channelizing devices are 28" traffic cones.
28'TRAFFIC CONE ROAO TOPT 4. Sign size can be a minimum of 48" x 48" and shall not
® BORE PIT WORK o obstruct pedestrian access.
EA
TRAFFIC FLOW AHO 5. Crew is required to leave a minimum of 11' for traveling
TtFLAGGER lane width.
6. Alert affected residents and businesses.
WORKVEHICLE I 7. Work to take place between 9 a.m. and 4 p.m.
8. Work area will be approx. 48' ECL of Olymic View Dr
SIGN LOCATION & 14' SCL of 190th PI SW.
WARNING FLAG 9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
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