ENG20170188-APPROVED PERMIT.pdfEDMO�ND�S,
CITY OF
121 5TH A VENUE NORTH - EDMONDS, WA 98020
to PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBS T *
Job Address: 9300 236TH ST SW, EDMONDS
1V1li LI�V1V!1 LAiL:IV1L:IN 1. r%Ix 1. 13"1VVL
GO EDMONDS SCHOOL DISTRICT 15
20420 68TH AVENUE W
LYNNWOOD, WA 98036
kD WIDENING, UTILITIES, SIDEWALK, RA
EW ORK PERMIT # BLD20161599
CONTRACTOR
FORMA CONSTRUCTION, COMPANY
C/O JAMES PHILLIPS
PO bOX 11489
OLYMPIA, WA 98508
LICENSE #: FORMACC878OREXP: 09/19/2017
HER WORK IN THE RIGHT OF WAYRELATED TC
Location:
ASS'i'SS'p.7!.'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
A1.I EYa ("0X0 I) 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 ofanykind or description whatsoever, foreseen or unforeseen, that may be 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 FORA PERIOD OF ONEYEAR FOLLOWING THEFINAL
INSPECTION AND. ACCEPTANCE OFTHEWORK.
• 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
posses'ion.
• 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 NOTICERIX)UIRED FOR ALL INSPECTION REQUESTS
THIS APPLICATION ISNOTA PERMITUNTTL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES AR
SPACE PROVIDED,,
FREAK "Y
Printed: Tuesday, May 23,201'
3 l �
(5('FILI, ,COPY F-1 INSPECTOR COPY E] APPLICANT COPY
Of EL7A4e-).
Z C, 1,8,0 0
ROW PERMIT NO.: ENGOU - C3
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME:
CONTRACTOR:
........ .. _
Mailln d 1l 7 rv+4
State License : i
f
C� Business License #
ADDRESS OR INTERSECTION OF CONSTRUCTION:
CONTACT:
Phone #
F x #:
Email #:
'ia'bility Insurance onded
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial
❑ Multi -Family
Subdivision
❑ Single Family
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
City Project
[Other
1'es ❑ No
Traffic Control (Only)
�YASSOCIATED PERMITS? BLD# 20161599 ENG#__
DESCRIPTION OF PROPOSED WORK (Be Specific) : /'q_g94Mwq or il/F1�t%
iGF�" LcJ /r1
WAS STREET OVERLAYED'IrII'IIIN THE LAST FIVE ;YEARS? 'SES NO 'lo'ear.
PAVEMENT CUT: 2 --yes ❑ No If yes, indicate size of cut: Mcclif—' x /9"'
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
RIGHT-OF-WAY DURATION
AREA TOTAL
CLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF SFS CL.)rfF&--T-!557Z)64
Alley 72 Hrs + LF X LF SFS
Parking 72 Hrs +, LF.._ _X ...µ ......_ L 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 stateme w � qd tlie permit requirements and acknowledge that I must
follow all requirements in o- o t to be valid.
SIGNATUREDATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
LLCFHCY._ _ TRAFFIC CONTROL PLAN
60 CKAZ
TRAFFFIC EDMONDS WA
ICCONE LDNE T
y EXISTING TRAFFIC FLOW
�. SIGN LOCATION
FMIOTECRVE V&M1CLE
OR WORN WINCLE NOT TO
......... .......................
,........ SCALE
�VAAA�CC
A].:rr1a.rE�As :F°tRi:r
o�raaa+r
w Aa RwiE..IAD GrAx �x ;Avr N i J:1
axvGaaa
k r C/0
f �
t�-OZM VTw U) BUFFER DATA
nevi . t __.....................
::1kdL7
LONGITUDINAL BUFFER SPACE 8
u 1r1 T SEED �) f qp
\J 0I}65 0
�'41h9R
W X X N PROTECTIVE VEHICLLi WITH TAM, ROLL AHEAD DISTANCE,.,,.,,
P
;r a I.x r4u a. �. a+°rs a rmx n u n..s wren
eL OZM I -LE VC Arx r LOAOEO ErMr OPE$ rw
W
Y
m ( N:o I[cAua r I lY LNS
H _ r w Acca+o na ru
30 MIN
MAW {pJ rMx IGMA
I IYW NP CE ITN
0 NVh A A, t MCwp'kXI
MIL ANCAD'4101FP04 MIAMHr„µEm A5$"$ My "PAvL.ANT
+n p w o lEA pWROFEL11iuT VEW�hT As AwALanMA�'D R'�GAd�H.�,'a E a
, Y TMA IS AVAA,AIRLE. IO ND RNA P$ A!'SL'113
3 ("NY7xEG1NE
O, VEAACEE SNALL DE STRATEGICALLT LOCATED N TIE FELO TGV
U 1 $$."0 TORAF&tl� AM Ips"nHOµL A &A C1 O f+A t£ tl5 s ECx GS
_ ........
w SIGN SPACING X (TO
Q O - YYI E 3w NO fA raIl flRH oadB ..k . {;
6d0//65 AMYPH
O X O 35/90MHH C1O"Y0O
.....m
O V
35J +
W I 25/30 MPH 200'
Q IN b 1 A 0 Ax V7 IYI 9
tlj�y" U bo St t 25 MPH LESS WOO +
O .,)._ CI 5 1 fiA A4 CNI qw GI •ryY d.
u
.,..
MlICAPE
IMIIM TAPER LENGTH L 14e T)
M1 DTH PolrTstl SW G 1 I
1Hlyj IfeeT) ,� so 31 ao so 5ss 5o "IT 1 1 ] S _9N 6 .I-- ...p....�.....oawn........
Malntaln I ICY min. -" O)
O lane width 1 (D g c tea-
CONES
2 ,, FOR DELINEATION
2 rM 3 ACED C. 15' ECsa
n 3 SPACED
I X TABLEw T +
0
V url
Z I «Wx
a �tW20-7a
CnNSTRIJCTION NOTFS
9
Y X
Z � i
Q c/7 Y' ddZOA,D E'
V Y'N
AHEAD wza-4
Y
Nq _........... _..__..........
J N IV
� �rwn
c+7
1
Q Y wa a
I ,1aArt GENERAL NOTES
W20-1
1. ALL SIGNS AND SPACING SHALL CONFORM TO THE MUTCD.
AND CITY OF EDMONDS SPECS.
2. PRIORITY PASSAGE THROUGH WORK AREA FOR EMERGENCY.
VEHICLES SHALL BE PROVIDED AT ALL TIMES.
3. ALERT METRO TRANSIT 5 DAYS IN ADVANCE (IF APPLICABLE),
°�........... ....... 4. PROTECTIVE VEHICLE RECOMMENDED-MAY BE A WORK VEHICLE.
5DEVICES SHALL NOT ENCROACH INTO ADJACENT LANES.
6. ALL SIGNS 48" X 48" B/O UNLESS OTHERWISE SPECIFIED.
DAVID DORLAND 7. CHANNELIZATION DEVICES ARE 28 INCH REFL CONES.
V 206, 282,420010 206786,3411 (see TABLE 1 for spacing distances).
Ew V� 1E1�%P�,4(adrC �, 8. ALL SPACING MAY BE ADJUSTED TO ACCOMMODATE AT GRADE
INTERSECTIONS AND/OR DRIVEWAYS.
9. FLAGGERS WILL CONTROL ALTERNATING ONE-WAY TRAFFIC.
n10.TAPERS WILL BE 50'-100' AND MUST CONTAIN A MIN OF
I LIAD 6 DEVICES.
11.ALERT AFFECTED RESIDENTS AND BUSINESSES