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ENG20170184-APPROVED PERMIT.pdf0 STATUS: ISSUED CITY EDMONDS 121 STH AVENUE NORTH - EDMONDS, WA 98020 PHONE: (425) 771-0220 - FAX: (425) 771-0221 *PERMIT MUST BE POSTED ON JOBSITE* ENG20170184 Permit Number: ENG20170184 Expiration Date: 12/18/2017 Job Address: 8609 244TH ST SW, EDMONDS Location: 8609 244TH ST SW GO Susan att: Sidick 1660 Park Lane Burlington, WA 98233 Work area is approx 29'N c/1 of 244th St SW & 71'0'-W'c anticipated. C/O Susan att. Sidick 1660 Park Lane Burlington, WA' 98233 (425)457-6353 LICENSE #: jnfras187 c2 EXP' 02/22/2 )19 ''''''■■ 111■ 1'3x5 concrete cut ASSESSED VALUE: $0;00 PROPERTY AREA: 0 SIDEWALK: ( OXO) DURATION IN MONTHS 0 FEE: $0,00 STREET DISRUPTION TRENCH CUT: ( 3 X 5 )' - 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 INDEMNITY The Applicant has signed an application which states he/she holds the City 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 ofits departments or employees,including but not limited to the defense ofany legal proceedings including defense costs and attorney fees by reason ofgranting this permit. THECONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A.'PERIOD OFONEYEAR FOLLOWING THE'FINAL INSPECTION AND ACCEPTANCE O F,THE W ORK. • Traffic Control and public safety shall be in accordance with City regulationsas 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 DIAL -A-DIG (1-800-424-5555) BEFORE ANY EXCAVATION CALL FOR INSPECTION (425) 771-0220'EXT. 1326 24 HOUR NOTICEREQUHtID FOR ALL INSPECTION REQUESTS CITY ENGINEER OR HIS/HER DEPUTY- AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED SPACE PROVIDED, RELEASED DATE ❑ FILE COPY F-]' INSPECTOR COPY ❑ APPLICANT COPY .4 OI' E04n, .NVC. I S<30. RECEIVED MAY 112017 BU11 , 11 `A'f ROW PERMIT NO.: ENG B" q ISSUE DATE: RIGHT-OF-WAY CONSTRUCTION PERMIT APPLICATION PROJECT NAME: 108597924 CONTRACTOR: PSE/Infrasource µ Mailing Address: 1660 Park Lane,Burlington, WA 98233 _._. State License #: INFRASL871C2 n City Business License #: NR -023614 CONTACT: Sue Sidick _. w ........... Phone #: 425-457-6353 Fax #: Email #: Susan.Sidick@pse.com Liability Insurance Bonded ADDRESS OR INTERSECTION OF CONSTRUCTION: 8609 244th ST SW 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 0 No ANY ASSOCIATED PERMITS? BLD#ITm� ENG# ..... DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 29' N c/1 of 244th ST SW & 710' W c/1 of Hwy 99. To cut and cap gas service at main. 1 3x5 concrete cut anticipated. WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES NO Year:108E:i PAVEMENT CUT: ❑ Yes ❑ No If yes, indicate size of cut: CONCRETE CUT: ® Yes ❑ No If yes, indicate size of cut: 3 x 5 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. 1 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. Susan Sidick an ss'nea es sau P 5/11/2017SIGNATURE DATE Contractor or Agent NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE o E 2 .2 �ur �• E E a'�c7oo B^e Q Z Z W O Z Q WF O U LLJ(q Z gI a LL — .- ao �m N ® 4 'd Z -V j Opu� U � Z WFn Fn Z Q y U` O C7 n r WMY 4 ami III 1-2 V� w . cN CL a�w 0 � a L L COsk E In O CID00 O o E 2 .2 �ur �• E E a'�c7oo B^e Q Z Z W O Z Q WF O U LLJ(q Z gI a LL — .- ao �m N ® 4 'd Z -V j Opu� U � Z WFn Fn Z Q y U` O C7 n r WMY 4 ami III JOB #: DATE: ROW PERMIT: START DATE: DURATION: WORK DESCRIPTION: 108597924 5/5/17 t dinonds ❑4 YES ❑ NO 06/26/17 PRE INSPECTIONREPORT At utain, cut and cap existing 5/8" PE svc., and remove meter. Alain in sidewalk. Need. laggers. PI.,AI" MAP'. 1 WAN8 C/t. C_,Au Fe).(9C S Aj 6 r O F p -gl�,t-IIS-t7 F-!77 " IT IP 29'N 9201 icy INSTALL METHOD Open Trench New Construct NOTE: ROW = 60' Wide PAV = 35' Wide "*Hydrant H16-63 is 331' from tie-in .............. „. ............. ............... ., ,, ........ %1 .kk.. 4::.l lttttt►t1II5..... C/L SS 12" CMP. Shoreline WORK LOCATION I Size of Cut or CL 74dih St SW & 710 C y of CL Hwv 99 3x5 Surface Type Concrete ❑ METER HOODS # ❑ NO PARKS # ❑ Template Bar ❑ Bollards 2.5" # ❑ Bollards 4" # ❑ FUEL LINE PERMIT NEEDED Fuel Line Length: Fuel Line Diameter: —_,,,,... IN S of CL & -- 'E W of CL INSofCL&-- ,EWofCL___--- -__-_-- _--- ❑� FLAGGERS # 2 35 MPH ❑ TROLLY LINES ❑ BUS STOP # ❑ OFFICERS # SPEED LIMIT ❑ TRAFFIC SIGNAL ARTERIAL ❑ Commercial ❑ Altered Commercial ❑ Leak Repair Service Information Residential ❑ Altered Residential ❑ CP Work Diameter Meter EFV Pressure ❑ Multi -Family ❑ Replacement Service ❑ Pothole 5/8" 0 250 ❑ 1800 ❑ 6r° WC �... New Constr„ ❑ Main Maintenance ❑ Extension ❑ 1-1/8" ❑ 425 ❑ 2600 ❑ 2# ❑ Stub ❑ Service Maintenance ❑ 1-1/4" 630 ❑ 10,000 ❑ yy Extension ❑ Valve Maintenance ❑ 2" 1000 ❑ 275 ❑ Complete SVC E] Cut &Cap I Meter Loc: - D3000 Surface Type Concrete ❑ METER HOODS # ❑ NO PARKS # ❑ Template Bar ❑ Bollards 2.5" # ❑ Bollards 4" # ❑ FUEL LINE PERMIT NEEDED Fuel Line Length: Fuel Line Diameter: —_,,,,...