ENG20170205-APPLICATION.pdfof EDt.10
ISSUE DATE:
PROJECT NAME: 106323153
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871102
City Business License #: NR -023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email 4: Susan.Sidick@pse.com
_�Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 8802 217th ST SW
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family FX] Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes F*_1 No
I ANY ASSOCIATED PERMITS? BLD# ENG# I
DESCRIPTION OF PROPOSED WORK (Be Specific): Work area is approx 20'N & 13'Sc/lof
217th ST SW & 133'W c/l of 88th AVE W 1 3x5 soft surface cut and 1 2x4 paving cut anticipated
to install gas service
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES ❑ NOE] Year: 106211
PAVEMENT CUT: X1 Yes ❑ No If yes, indicate size of cut: 2 x 4
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: X_
RIGHT-OF-WAY DURATION
CLOSURE AREA]LF
TOTAL (NUMBER OF MONTHS)
Sidewalk 48 Hrs +F�LF X SF
Alley 72 Hrs + LF X SF
Parking 72 Hrs + LF X 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.
Susan Sidick D�da�,9 d5ss�, 04/18/2017
DN:m Susan Sid k, o=Puget So dE.w.w Stre Use
SIGNATURE Pe,ema=a"� bgne�,`=°s DATE
Date: 201609.300]:5]]0 -0T00' _.._...
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
JOB #:
106323153
DATE:
4/6/17
JURISDICTION:
Ednionds
ROW PERMIT:
YES NO
START DATE:
DURATION:
I day
WORK DESCFJPTION:
ADDRESS:
8802 217th St Sw
CITY/ZfP:
Edmonds 98026
CUSTOMER:
PM:
Eric Whitehead 206-930-78"3'1
P "I PHONE NUMBER
Jordan McLean 425-563-3703
T,>noomin'install 4gorux 75'Yf/-118"11Excumc'and set un112J0omter /78neeJon,residential
PLAT MAP: 1 16zL 068
8802 L2 nes. Bollards
A250 MSA
INSTALL METHOD
WORK LOCATION
Open Trench
F-1
New Construct
[21
Existim
F]
Hydrant H13 -10A is
380'from tie-in.
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SWR
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WORK LOCATION
Size of Cut
Surface Type
'1of CL
FLAGGERS #
MPH
TROLLY LINES
BUS STOP #
F] METER HOODS #
OFFICERS #
SPEED UMIT
TRAFFIC SIGNAL
ARTERIAL
NO PARKS #
commercial F]
Altered Commercial
Ej
Leak Repair Service Information
Template Bar
Residential
Altered Residential
CP Work Diameter
Meter
EFV
Pressure E] Bollards 2.5" #
MUlti-FaMily
Replacement Service
Pothole n 5/8"
E]
250 E] 1800
6" WC Ej Bollards 4" #
F]
New Constr.
Main Maintenance
F
_#
Stub
service maintenance
1-1/4"
630 El 10,000
25# FUEL LINE PERMIT NEEDED
El
Extension
Valve Maintenance
2"
H
1000 E] 775
Fuel Line Length:
n/
complete Sery E]
Cut & Cap I Meter Loc:
OR 08
D3000
Fuel Line Diameter:
Notes:
1. All signs and spacing to conform to the MUTCD
and City of Edmonds standards.
2. All sidewalks, driveways, exits and egresses shall be
completely clear unless otherwise indicated.
3, Channelizing devices are 28" traffic cones.
4. Sign size can be a minimum of 48" x 48" and shall not
obstruct pedestrian access.
5. Crew is required to leave a minimum of 11' for traveling
lane width.
6. Alert affected residents and businesses. CV3�M�7. Work to take lace between 9 a.m. and 4 m. op p�
8. Work area will be 133' WCL of 88th AV W
& approximately 20' NCL of 217th St SW.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
217TH ST SW
Jp
k r
t Use maximum
' space available
for sign
---------------------------
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LEGEND
28" TRAFFIC CONE
® BORE PIT
TRAFFIC FLOW
WORK VEHICLE
1+ SIGN LOCATION
+ WARNING FLAG
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80
35/45 30 60
25/30 20 40
2098#
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Notes:
1. All signs and spacing to conform to the MUTCD
and City of Edmonds standards.
2. All sidewalks, driveways, exits and egresses shall be
completely clear unless otherwise indicated.
3. Channelizing devices are 28" traffic cones.
4. Sign size can be a minimum of 48" x 48" and shall not
obstruct pedestrian access.
5. Crew is required to leave a minimum of 11' for traveling
lane width.
6. Alert affected residents and businesses.
7. Work to take place between 9 a.m. and 4 p.m.
8. Work area will be 133' WCL of 88th Av W
& approximately 13' NCL of 217th St SW.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
os
217TH ST SW
2 a
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PUGET'
SOUND
Job#106323153
8802 217th St SW Edmonds, WA
April 15, 2017
Sheet 2 of 2 stephen.gadke@pse.com
(425) 424-6431
Use maximum a
space available it 0
for sign
Iq
17 117