ENG20170339-APPROVED PERMIT.pdf1 so .
STATUS: ISSUED .
CITY FED.
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
ENG20170
Permit Number:ENG20170339 Expiration Date: 04/09/2018
Job Address: 18816 OLYMPIC VIEW DR,,EDMONDS Location: 18816 OLYMPIC VIEW DR
P.O. BOX H
EVERETT, WA 98206
P O BOX H
EVERET,T, WA 98206
(425)670-3216
LICENSE #: UBL 313 005 741 EXP%
Install Pri UG line Ext for new construction on house. PUD to install a primary riser on pole/road bore to be done by PUD. Assigned
bore contractor from pole to property at 18816 Olympic View Dr. PUD to pull wire from pole to transfomner.
DISR(IPTION INFORMATION
ASSES'sI- VALUE. $0„00 PROPERTY AREA: 0
SIDEWALK: (OXO') DURATION IN MONTHS: 0: FEE $0,00 STREET DISRUPTION TRENCH CUT:; ( 0 X 0 );
PARKING: ( OXO) DURATION IN MONTHS: 0 FEE $0,00 YEAR OF OVERLAY: 0; FEE. $0,00'
ALLEY, ( OXO ,) DURATION IN MONTHS 0 FEE' $0,00_
INDEMNITY: The Applicant has, signed an application ivhich states he/she holds the City of Edmonds harmless from injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or
any of its 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 RESPONSIBLEFOR;WORKMANSHIP `AND MATERIALS FOR A PERIOD OFONEYEAR 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
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 ofthe '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 NOTICE111,OQUIRED FOR ALL INSPECTION REQUESTS_
THIS APPLICATION IS NOTA PERMITUNTIL SIGNED IBY ''IHE C17Y ENGINEER OK HIWHhK DhY U IY: AND PEES AKE PAID, AND KLCL
SPACE PROVIDED;
Printed:
DA
CNOWLEDGED IN
FILE COPY INSPECTOR COPY ❑ APPLICANT COPY
• Restore ROW to City standards
• Restore Landscape to like or better conditions.
• Call for locates of underground utilities prior to any excavation.
• Alert affected residents and/or businesses prior to work start.
• Conform to approved working drawings and Traffic Control plan.
• Verify clear bore crossings
• Utility patch restoration to be in accordance with Edmonds Standard detail E2.3
• Maintain erosion &sedimentation control, Keep street clean.
• Call for required inspections as noted.
• Traffic Control per approved plan and MUTCD. Refer to City of Edmonds traffic control requirements.
• Applicant shall repau•/replace all damage to utilities or fi•ontage improvements in City right-of-way per City standards that is
caused by or occurs during the permitted project.
• Sound/Noise originating from temporary construction sites as a result of construction'' activity are exempt fromthenoise ' mits
of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on weekdays and 10:00am and 6:00pm on Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must comply with the
noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
• Applicant, on behalf of his or her spouse,' heirs, assigns, and successors in interests, agrees to indemnify defend and hold'
harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for 'damages 'of
whatever nature, arising: directly or indirectly from the issuance ofthis permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance not limit in any way the City's ability to enforce any ordinance
provision.
INSPFCTIONS
• E-Traffic Control
• E Engineering Final
PARTIAL INSPECTION DATE: INITIAL• NOTES„
PARTIAL INSPECTION DATE: INITIAL:. NOTES;*
FINAL INSPECTION APPROVED DATE; INITIAL:
MEM
-ROW PERMIT NO.: ENG, 337
V� O�:* 1 OCR 2d� (j8811E DATE:
WGHT-OF-WAY CONSTRUCTION
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PERM '' IT "PLIC AT A �.°f
PROJECT NAME: ^ �, A� � CONTACT: � L �
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CONTRACTOR: c� Phone #. f
MailingAddress: _
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State License #�
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City Business License #: _... Liability Insurance Bonded
. ADDRESS
OR INTERSECTION OF CONSTRUCTION: ` <� <�, (o : 0,4 VvN k`
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
-���8ubdivision m
Commercial City Project Traffic Control (Only)
❑ Multi -Family, ❑ Single Family ❑ Other
[] EUC '(PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes' No
FA�WASSOCIATED PERMITS?
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DE$CTIIP"I"ION OF PROPOSED WORK. (Be Specific) : U "vie—
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WAS
PAVEMENT CUT: ❑ Yes 14 No
CONCRETE CUT: ❑ Yes No
LAST FIVE
If yes, indicate size of cut:.
YESU NOUwwYear: Year:.:
x
It yes, indicate size of cut:'.
M,
APPLICANT TO READ AND SIGN
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*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 (WAQ 296-155-305 and must have: certification
verifying completion of the required training in theirpos session.
*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 I .
Indemnity. The Applicant has signed an application which states h ' elshe hold the City of
Edmonds harmless from injuries, damages or claims of any kind or description
whatsoever, foreseen or unforeseen, that maybe made against the City of Edmonds ' or.
any of its departments or employees, including defense costs and attorney fes 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 f6r the permit to be v�_,_
SIGNATURE DATE
ntractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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SWERK RESIDENCE
18816 OLYMPIC VIEW DRIVE
EDMONDS, WA 98020