ENG20170249-APPLICATION.pdf10
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ROW PERMIT NO.: ENG
ISSUE DATE:
PROJECT NAME: 106324847
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871C2
City Business License #: NR -023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidicl<@pse.com
F1 Liability Insurance [I Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 22014 92nd AVE W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F-1 Commercial 0 Subdivision El City Project F-1 Traffic Control (Only)
F] Multi -Family X Single Family F Other
F-1 EUC (PUD, VE RIZON, PSE,
COMCAST, OVWSD):
Is this permit pail of a blanket permit? ❑ Yes No
I ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific): Work area is approx 145's c/l of 220th ST SW
& 20'E & 15'W c/l of 92nd AVE W
1 3x5 soft surface cut on the west side of the row in the gravel with be Edmonds row. Please rush
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES El NO El Year: 10621 �
PAVEMENT CUT: Z Yes Z No If yes, indicate size of cut: x
CONCRETE CUT: F-1 Yes F-1 No If yes, indicate size of cut: X
RIGHT-OF-WAY DURATION
AREA TOTAL
CLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF SF
Alley 72 Hrs + LF X LF ]SF
Parking 72 Hrs + LF X LF
APPLICANT TO READ AND -
*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'§ao-a��s-S°�'°� DATE
D.% YO,E.M 3001: 5] 30-0 0 6/26/2017
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Job #:
106324847
Data:
5/15/17
Address:
Jurisdiction:
UniCzSno
City /Zip:
Right nfWay Permit?
R] YES [] NO
Customer
Est. Start Date:
07/03/17
PK8/|nop
Est. Duration:
8Houns
AND 45' OF 1-118" PESCA TCXT SFT,4250 1145A A T
22014 92M) AYEVV
Edmonds 98020
ERIC MATHIEU 813-482-6566
PHONE NUMBER
Construction Method
WORK DESCRIPTION:
INSTALL 50' OF
1-118"PESCA T STUR
AND 45' OF 1-118" PESCA TCXT SFT,4250 1145A A T
Open Trench E]
Trenchless
6 IN WC 01,Q
PLAT MAP: 165067
220TH ST SW
PIL
LLJ
Cr
CIL S
Work Location
Of Cut Surface Type
'N ofC
FLAGGERS #
MPH
TROLLY LINES BUS STOP #
METER HOODS #
OFFICERS #
SPEED LIMIT
TRAFFIC SIGNAL ARTERIAL
NO PARKS #
0
Commercial F-1
Altered Commercial
Leak Repair Service Information
E] Template Bar
Residential F
Altered Residential
CP Work Diameter Meter
EFV
[:] Bollards 2.5" #
Multi -Family E]
Replacement Service
E]
Pothole 5/8" 250
1800 E] Bollards 4" #
F]
New Constr. F
Main Maintenance
Extension 11/8" 425
2600
F/�
Stub
service maintenance
E] 11/4" 630
10,000 FUEL LINE PERMIT NEEDED
Extension F_
valve maintenance
2" 1000
Fuel Line Length:
Compete Sery
Cut & Cap
Mtr Loc: O/R
Fuel Line Diameter:
l
200'
220TH ST W
0
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receiving pit ; E1.
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Ej:
22014 E " allow 12' minimum
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s
Notes:
1. All signs and spacing to conform to the MUTCD
and Snohomish County 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 145' SCL of 220th St SW & 20' ECL
of 92nd Ave W
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80
35/45 30 60
25/30 20 40
PLIGET
S ND
®
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Job#106324847
22014 92nd AVE W, Edmonds, Sno Co, WA
FLAGGER
June 19, 2017
Sheet 1 of 2 yuriy.bashtovoy@pse.com
(425) 398-6193
220TH ST W
0
J
n I
receiving pit ; E1.
^ `
Ej:
22014 E " allow 12' minimum
olm y
a
0
s
Notes:
1. All signs and spacing to conform to the MUTCD
and Snohomish County 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 145' SCL of 220th St SW & 20' ECL
of 92nd Ave W
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80
35/45 30 60
25/30 20 40
LEGEND
28" TRAFFIC CONE
®
BORE PIT
�^
TRAFFIC FLOW
FLAGGER
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
------------------------------
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------------------------
-----------------------------
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Notes:
1. All signs and spacing to conform to the MUTCD
and Snohomish County 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 145SCL of 220th St SW & 15'
WCL of 92nd Ave W
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80
35/45 30 60
25130 20 40
PUGET
OUND
ENERGY
Job#106324847
22014 92nd AVE W, Edmonds, Sno Co, WA
June 19, 2017
Sheet 2 of 2 yuriy.bashtovoy@pse.com
(425) 398-6193
VL
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220TH
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LEGEND
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TRAFFIC FLOW
FLAGGER
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
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