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ENG20170400-APPLICATION.pdfr� OV EL)1140 � 2 ROW PERMIT NO.: ENC.. ISSUE DATE: MIiI[,r-o11l -WAY CONSTRUCTION P>liRI`V RT .III" P LII(CATII®IkI PROJECT NAME: 887033545 CONTACT: Susan Sidick CONTRACTOR: PSE/Infrasource Pholle #: 425-457-6353 Mailing Address: 1660 Park Lane Burlington Wa 98233 Fax #: State License #: INFRASL871C2 Email 9F: susan.sidick@pse.com City Utasiness License 0: NR-023614 ❑ Liability Insurance ❑ Bowled ADDRESS OR INTERSECTION O}i' CONSTRUCTION: 220th ST SW & HWY-99 ROW W )RIK ASSOCIATED WI[7[ H THE FOLLOWING TYPE OIL+' PROJECT: � n Couttnereial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only) ❑ Multi-I+atnily ❑ Single I+ainily ❑ Other ❑ EUC (PUD, VERIZON, PSE, COMCAST, OVWSD): Is this permit pact of a blanket perinit? ❑ Yes ❑ No ANY ASSOCIATED PERMITS? BLD# ENG# DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 26' S c/1 of 220th ST SW & 57' E c/l of HWY 99 to perform yearly inspection G1-1785514 at the test leadwire box. Please rush WAS STREET OVERLAYEID WITHIN THE LAST I+IVE (5) VEARS? VES ❑ NO ❑ Year: PAVEMENT CUT: ❑ Yes © No If yes, indicate size of cut: x CONCRETE CUT: ❑ Ves ❑ No If yes, indicate size of cut: X RIGHT-OF-WAY CLOSURE AREA TOTAL DURATION (NUMBER OF MONTHS) Sidewalk 48 Hrs +� LF X LF SF Ailey 12 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. Indemnify: The Applicant has signed an application which states he%he hold the City of Edmonds harmless from injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may he 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. 1 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 SrgW slGi/G�f DATE 10/05/2017 Contractor or Agent NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Date of Request: Job number: Job address Project mgr: PM email: 10/03/17 887033545 220th St SW & Hwy-99 City: Edmonds Zip: Betty Frank betty.frank@pse.com Estimated job start date: Estimated job completion date: Description of work to be performed: 11/03/17 11 /03/17 PM contact #: (206) 716-2641 '-.• .. yearly inspection ' at -• luire ••. located at 96'of 1 St SN81 Pavement cut? Yes No If yes, Dimensions of Cut: Length Width How many cuts? Surface Type n/a Require trenching? "I Fv(]No If yes, Dimensions of trench: Length Width Method of installation: Traffic impact: Road closed FYes FNo Lane closed Oyes FNO How Many? 1 Shoulder closed FlYes No Sidewalk closed "Yes ® No Emergency Contact: Cell Number: Depth Direction? West PUGET SOUND ENERGY PROJECT LOCATED AT 26' Scl 220th ST SW & 57' Ed Hwy 99 Mountlake Terrace, WA 98026 DURATION OF WORK APPROXIMATELY 15 MINUTES HOURS OF OPERATION M-F, 9AM-4PM Sazp-pLAN- BETTY FRANK Engineering Assistant Puget Sound Energy Corrosion Protection Dept. Cell # 206-396-9244 Email. be frank pse.com LEGENDS TRAFFIC DIRECTION TEM .TRAFFIC DIRECTION 0 0 00 CHANNELIZING DEVICE N ADVANCE WARNING SIGN LOCATION T-19L 28" TRAFFIC -&CONES N s NOT TO SCALE TRAFFIC CONTROL PLAN #1 OF 1 WORK IN INTERSECTION REASON, PREFORM YEARLY READ ATTEST LEAD WIRE BOX a / 220TH ST SW �. ACTIVITY ATTACH SIGN 165, 100, / / / AREA SEQUENCE (A) TAPER TANGENT 100' SIGN SEQUENCE A N N N *RIGHTLAN)E X X W4-2L W2SEDEAD SPACING TABLE X 200'+/- CHANNELIZINGDEVICESSPACING (FEET) MPH I TAPER I TANGENT 20/301 20 1 40 W20-5R NOTES: 1. MAINTAIN A MINIMUM OF ONE ACCESS POINT FOR EACH BUSINESS WITHIN WORKAREA LIMITS. 2. ALERT METRO TRANSIT PRIOR START OF WORK. TANGENT 165' T19L TAPER ATTACH SIGN SEQUENCE (A) TRAFFIC CONTROL SERVICES FELIPE J. MACIAS, TCS #002M in ek(8trnnm OFFICE # (425) 658.3656 NOVEMBER 24, 2014 Location: 26ft Scl 220 St SW & 57ft Ecl Hwy-99 Work Description: Perform yearly maintenance and get read test lead wire box Excavation : No digging or cutting Lane Closure: 1 Eastbound lane of 220 St SW Duration: 15 mins a- E S T _. sirin„�ndi .. . E T Aim f Test Lead wire box location: 26' Scl 220 St SW & 57' Ecl i Hwy-99 TS-034202 —street view showing location of wire box at 220 St SW & Hwy-99 : 2M WA,%. EMuaCs. Vtutrjgtw. kkA#d 5'.sits ir, eu u ' -n-n <y> 15 mins of Lane closure/Eastbound lane of 220 St SW to perform yearly maintenance on PSE test lead box. No digging, cutting etc. Takes approx. 10mins Location of Test Lead wire box