ENG20170220-APPLICATION.pdfI'1 11111 11 1 1 1 1 1 ' I
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PROJECT NAME: 106325281
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871C2
City Business License #: N R-023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
F-1 Liability Insurance [:1 Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 1054 Walnut St
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F] Commercial 0 Subdivision Ej City Project [:] Traffic Control (Only)
F1 Multi -Family FX_1 Single Family F] Other
F] EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes n* No
� ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific): Work area is approx 21' S C/l of Walnut St
& 135'W c/l of 96th AVE W 1 3x5 concrete cut anticipated.
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES El NO El Year: 1062i
PAVEMENT CUT: X1 Yes F1 No If yes, indicate size of cut: -x
CONCRETE CUT: F-1 Yes n No If yes, indicate size of cut: 3 x 5
=RIGHT-OF-WAY DURATIONAREA TOTAL (NUMBER 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 ��a � aft ��= -5tr�`°� DATE
Da,:216, .90075'/MO-0 6/5/2017
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
WORK DESCRIPTION:
PRE -INSPECTION '
Job #:
1���2���1
Date:
5/26/17
Address:
1O54WALNUT 5T
Jurisdiction:
Edmonds
City/Zip:
EbkAON[)5 98020
Right ofWay Permit?
M Yes [] NO
Customer:
TDW)ECHELBAP&ER
425-673-1100
Est. Start Date:
07/24/17
PM/|nnp:
Kior,o Hays
4255213 g�O5
Est. Duration:
G Hours
PHONE NUMB R
WORK DESCRIPTION:
Construction Method
PLAT MAP: 163 067
WALNUT ST
SIDEWALK 0
CL
G 6" STW IP 21' S SIDEWALK G
2187-1960
Uj
11701
85'FROM TIE IN LOCATION
Work Location
Size
of Cut
Surface Type
CONCRETE
3X5
F1
FLAGGERS # MPH F1
TROLLY LINES BUS STOP #
METER HOODS #
OFFICERS # SPEED LIMIT F]
TRAFFIC SIGNAL ARTERIAL
NO PARKS#
commercial Altered Commercial E]
Leak Repair Service Information
E] Template Bar
E]
Residential Altered Residential Ej
Multi -Family E] Replacement Service E)
New Constr. Main Maintenance
CP Work Diameter Meter EFV
Pothole 5/8" 250
Extension 11/8" 425
1800
2600
[:] Bollards 2.5" #
E] Bollards 4" #
Stub service maintenance
F] 11/4" M 630 M
10,000 M FUEL LINE PERMIT NEEDED
Extension valve maintenance
E] 2" El 1000
Fuel Line Length:
Compete Sery E] Cut & Cap
Mtr Loc: O/R
Fuel Line Diameter:
-------- ----
��m
hoz
R9-11
PLACE SIGNS
AT 9TH AVE S
INTERSECTION
CHANNELIZATION
DEVICE SPACING
MPH I TAPER TANGENT
55n0I 40 1 80
35145 300
25130 20 40
Notes:
1. All signs and spacing to conform to the MUTCD
and City of Edmonds standard .
2. All sidewalks, ddveways, exits and egresses shall be
completely clear unless otherwise indicated.
3. Channelizing devices are 28' f affic cones.
4. Sign size can be a minimum of 41 x 48' and shall not
obs Wct 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 behveen 9 a.m, and 4 p.m.
8. Work area vnll be 135' WCL of 96th Ave W & 21' SCL of
Walnut St.
PLACE SIGNS ON
9. If used, place NO -PARK signs 72 hours in advance
BOTH SIDES OF
of the day that the work is to be done.
WORKING AREA
Walnut St
LEGEND
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RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
PRINT ON
11X17" SHEETS ONLY
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Job#106325281
1054 Walnut St Edmonds, WA
June 1st, 2017
Sheet 1 of 1 milchell.peterson@pse.com
425-398-6071
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