ENG20170173-APPROVED PERMIT.pdfSTATUS: ISSUED
CITY
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
ENG20170173
RIGHT OF WAY PERMIT (3 -Commercial)
Job Address: 1"12 5TH AVE S, EDMONDS
rxpiratlon nate:
Location: 1112 5TH AVE;S
COBLAKEATWELL C/O BLAKE ATWELL
5800A 188TH ST SW 5800A 188TH ST SW
LYNNWOOD, WA98037 LYNNWOOD, WA 98037
(425)'232-2419
LICENSE 4: LOBERR*972K8 EXP: 06/05/2019
Temporarily park truck in the alley behind Savvy Traveler to load and unload roofing material.
ASSESSED' VALUE:` $0;:00` PROPERTY AREA 0
SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0.00 STREET DISRUPTION TRENCH CUT: ( 0 X 0')
PARKING: ( 0X0,) DURATION IN MONTHS: 0 FEE: $0,,00 YEAR OF OVERLAY; 0: FEE: $0,,00
ALLEY, 0X0) DURATION IN MONTHS: 0 FEE: $0,00
TNDEMIVTTY The Applicant has signed an application which states he/she holds the Cily of Edmonds harmless from injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen,' that may made against the City of Edmonds or
any ofils departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorney fees by reason ofgranling this permit.
THE CONTRACTOR IS RESPONSIBLEITOR`W0RKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING>THE FINAL
INSPEC TIO N AND ACCEPTANCEOFTHE WORV,
• 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 ofthe required, training in their
possesion.
• Restoration is to be in accordance with City codes. All street -cut trench work shall be°patched with asphalt or City approved
material prior to the end ofthe workday -NO EXCEPTIONS.
• Three sets ofconstruction drawings ofproposed work are required with the permit application'.
CALL D1ALrA-DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICEREQUIRED'FOR ALL INSPECTION REQUESTS
APPLICATIONAPPROVAL
THIS APPLICATION IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED,,
Printed: Wednesday, June 07 2017
RELEASED BY '
071111
COPY F-]' INS PECTOR COPY
APPLICANT COPY
I., of 1EVAtn.
-'A/c, i s9k)
PROJECT NAME:
CONTRACTOR:
1-SSOCi Gt4e� -70b q,, ij- 81,oac 17 req q
SCANNED
MAY 03 2017
ROW PERMIT NO.: ENG -7
ISSUE DATE:
RtGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
Mailing Address:
State License #: ,,
ffa,-� 6,_foi CONTACT:
Phone #: 4
Fax #:
ftj/ Email #: Ci
City Business.Licens
............ . .............. ........... ..... . ........... . ............................... .
ADDRESS OR INTERSECTION OF CONSTRUCTION:
Liability Insurance
Bonded
,ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE Of PROJECT:
1� Commercial Subdivision -City Project. ..... .. . -[::I -Traffic Control (Only)
DQ Multi -Family 0 Single Family ❑ Other
F1 EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this pen -nit part of a blanket permit? ❑ Yes ❑ No
I ANY ASSOCIATED PERMITS? BLD# -P170113
PR -
OPOS
DESCRIPTION OF D WORK (Be Specific):
'10
. . . . . .......... . ... . . . ....... . ... . ........................... . . . . . . . -.-- ............ . .................
Ljy�ST�REEI: OVERLAYED WITHIN THE LAST FIVE (5) YEARS? VfS_ NO Year:
........ . . . . . ..........
PAVEMENT CUT: El Yes No if yes, indicate size of cut: X,
CONCRETE CUT: El Yes No If yes, indicate size of cut:
RIGHT-OF-WAY
AREA
LF I X I LF
11 LF X
LF I X
TOTAL
LF
SF
DURATION
(NUMBER OF MONTHS)
APPLICANT TO READ AND SIGN
i
'.:
*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 or r f, IW pe to be valid. r
SIGNATURE DATE
_&�
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE