ENG20170176-APPROVED PERMIT.pdftit t��r
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBS;`.*
STATUS: ISSUED ENG20170176
Permit Number: ENG20170176
Expiration Date: 12/22/2017
Job Address: 8721 ST SW, EDMONDS
Location: 8721 218TH ST SW
PSF/Infrasource
CONTRACTOR
PSE/Infrasource
GO Susan att: Sidick
C/O Susan'att: Sidick
1660 Park Lane
1660 Park Lane
Burlington, WA 98233
Burlington, WA 98233
(425)'457-6353
LICENSE #: infrasl87;1 c2
` EXP: 02/22/2019
Install gas s ervice, work will consist of3'x5'bore pit at 13',S,c/1,of218 St SW hole hog to receiving 2'x8' bore pit ZNc/I of 218 St SW at
34'W cl of 87PL W. Anticipated l,day of work.
------------------
DISRtJPTION INFORMATION
ASSESSED VALUE: $0,00 PROPERTY AREA 0
SIDEWALK (OXO) DURATION IN MONTHS: 0 FEE $0,00 STREET DISRUPTION TRENCH CUT: ( 3 X 5 )
PARKING: ( OXO,) DURATION IN MONTHS: 0 FEE. $0,00 YEAR OF OVERLAY: 0FEE: $0,00
ALLEY: -- (.OXO) DURATION IN MONTHS: 0 FEE. $0,00
INDEMNITY The Applicant has signed an application ivhich states he/she holds the City of Edmonds harmless from injuries,
damages or claims ofany kind or description N,halsoeiyer, foreseen or unforeseen, that may be made against the City ofEdmonds or
any of its departments or employees, including but not limited to the defense of anylegal proceedings including defense costs and
attorney fees by reason ofgranting this permit,
THE CONTRACTOR IS`RESPONSIBLEFOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCEOFTHEM' ORK
• 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
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 of the workday- NO EXCEPTIONS.
• Three sets of construction drawings' of proposed work are required with the permit application.
CALL DIALrA-DIG (1,-500-424-5555) BEFOREANY EXCAVATION
CALL FOR INSPECTION (425)'771-0220 EXT. 1326
24 HO LIR NO TTC E REQ UIRED FOR ALL INSPECTIO N REQ UESTS
I' THIS APPLICATION
SPACE PROVIDED„
(/2-2-'/2-017
ASED BY
Printed: Thursda , June 22
,2,201
❑ FILE COPY ❑ INSPECTOR COPY r-] APPLICANT COPY
• Restore ROW to City standards
•: Restore Landscape to like or better conditions.
• ' Call for locates of underground utilities prior to any excavation.
• Alert affected 'residents and/or businessesprior to work start.
• Conform to approved working drawings and Traffic Control plan.
•, Verify clear bore crossings
• Utility patch restoration to be in accordance with Edmonds Standard detail E2.3
• Maintainerosion .& sedimentation control. Keep street clean.
• Call for required' inspections as noted.
• Traffic Control per approved plan; and MUTCD. Refer to City of Edmonds traffic control requirements.
• Applicant shall repair/replace all damage to utilities or fi•ontage improvements in City right-of-way per City standards that is
caused by or occurs during the permitted project.
• Sound/Noise originating from temporary construction sites as a result of construction activity are exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00amtto 6:00pm on weekdays and 10:00am and 6:00pm on Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must comply with the
noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
• Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirements; of any City ordinance not limit in any way the City's ability to enforce any ordinance
provision.
• &Engineering Final
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
of Et?A,1O""�s
2017wam
MAI 04 2017
BUILDING ROW PERMIT NO.: ENG' 0 -01-7 0
ISSUE DATE:
:GST -OF -WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 8721 218 ST SW
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 E
J Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 8721 218 St SW Job# 106322314
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
.... ..............
Commercial Subdivision City Project Traffic Control (Only)
❑ Multi -Family 0 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) • Install gas service, work will consist of 3'X F bore
pit at 13'S C/L of 218 St SW hole hog to receiving 2'X 8' bore pit 2'N C/L of 218 St SW at 34'W CL of 87 PI W.,.
Anticipated 1 day of work - Job # 106322314
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES [—] NO X Year: 872
PAVEMENT CUT: ® Yes ❑ No
CONCRETE CUT: ❑ Yes ❑ No
If yes, indicate size of cut: 3x5 and x part of 2'X8'
If yes, indicate size of cut: x
RIGHT-OF-WAY DURATION
CLOSURE AREA TOTAL UMBER 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 P�
,�„ �.�r DATE 5/4/2017
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
JOB #:
DATE:
ROW PERMIT:
START DATE:
DURATION:
WORK DESCRIPT[ON:
PRE -INSPECTION REPORT
106322314
4/27/17 ADDRESS: 8721 218th St Sw
Edmonds CITY/ZIP: Edmonds 98026
CU, I I'lNUMIJItK
E] YES ❑ NO CUSTOMER: Select Homes 206-730-0670
PM: "mill- f•turn rnrce
Jordan McLean 425-563-3703
From main, install approx. 170' of 1-1/8" PE scat/pial svc., and sel an A425 meler. Cuslomer provided
ocnduil.
PLAT MAP: ll 164. 068
INSTALL METHOD
.. `renc hTess L✓
Open Trench [
New Construct
8721
NOTE:
Stub: 30'
_ Ext: 140'
NA425 MSA Power, CTV, Fiber,
C P/L all OH.
ai .. ,-. ,..m...... No Curb/gutter
a G 1 -- No sidewalk
I ROW = 50' Wide
PAV = 18' Wide
8711 *Hydrant H13 -7B is
i 1 176' East of tie-in"
w1 j
M i
k. T1....,,............................................................................... a , .....,. ,Storm 12
„ .,,....,,..,..... ,.........,h,..,, Br�Cbt TJI
..... .....
SWR 8" Conc,
-- -------------- ........................ * ...........
-------- ---- 3.---_-_ _ -._._-- --._-.m_ _..._. _.. -__------__-G/6
WORK LOCATION I Size of Cut Surface Ty
'FQf CL 218th St iw & 34 'E f CL 87th P1 W 3x5 Asphalt
--2..._ M of CL _.....m...2.11Ik&Ut SW &_J�_ of CL ... _..._..._$Z RL1 '. _.._.._ 2x8 Asphalt/Si
'N S of CL
a ............ .....�
& 'E
W of CL
_.._.
❑
FLAGGERS #
MPH
❑
TROLLY LINES
❑
BUS STOP #
❑ METER HOODS #
❑
OFFICERS #
SPEED LIMIT
❑
TRAFFIC SIGNAL
❑
ARTERIAL
❑ NO PARKS #
❑
Commercial
❑
Altered Commercial
❑
Leak Repair
I Service Information
❑ Template Bar
❑
Residential
❑
Altered Residential
❑
CP Work
Diameter
Meter
EFV
Pressure
❑ Bollards 2.5" #
❑
Multi -Family
❑
Replacement Service
❑
Pothole
❑ 5/8"
❑
250 ❑ 1800
Q 6" WC
❑ Bollards 4" #
Q
New Constr.
❑
Main Maintenance
❑
Extension
❑ 1-1/8"
Q
425 Q 2600
❑ 2#
❑
Stub
❑
service Maintenance
❑ 1-1/4"
❑
630 ❑ 10,000
❑ 25#
❑ FUEL LINE PERMIT NEEDED
Extension
❑
Valve Maintenance
❑ 2"
B
1000 F]775
Fuel Line Length:
❑✓
Complete SVC
E]Cut
& Cap Meter Loc:
OR
D3000
Fuel Line Diameter:
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