ENG20180106-APPLICATION.pdfof EVA,10
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 109110256
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871 C2
City Business License #: NR-023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 19011 Olympic View Dr
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑X Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes W No
ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 10' E c/I of Olympic View Dr
& 254' N 190th PL SW also 32' E c/I Olympic View Dr & 204' N c/I of 190tyh PL SW . To install gas service
1 -3x5 paving cut and 1 - 3x5 grass/ dirt
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year: 109h
PAVEMENT CUT: ® Yes ❑ No If yes, indicate size of cut: 3 x 5
CONCRETE CUT: ❑ Yes ❑ 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
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.
Susan Sidick e§�be� 3/7/2018
M: m=3asan SMItic, o=Pn t Sm W EneW w=StreetU.
SIGNATURE Pe�'e�= e ane""��a�.`=�5 DATE
Ua a: 2016.0330 0T5T90 -0T00'
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
6?91oM*.3va Bom b3atl0 NY3d eZ .00t I OE/9Z I OZ 04 045 OZf 94Z 084 SZl 08 ZL
uB10e`Y 1933 Sal
a-�xosuM13VIX03101
b085BL N t 80
L- 6N,+u•�3 orb +as a
`'� glwea=s•a?�smwa>71aL
y woo•tueure6eueualpen'noam
666E E9L 006
'NO M31A OldWA1010
103 ,ZE 2 MS Id Hi061 Jo ION ,40Z aq pua ewe )POM pumeS'NO M3IA
OldWll0Jo103,01,VMS1dHIM 10ION ,45Zeg11VAa9je)poMls3lj
•w•d 4 pue •w•e 6 ume4oci could aNul of A/oM
•sossoulsnq pug sluaplsa3 poloage Poly
•41pvn auel 6mlaneal /ol dt 10 wnwioiw a RABBI o) po31nbo3 sl ma30
De
ov/5£
IBM
'09s
54/5£
0E
09
•g
'L
•g
ST94
ssros
•Dos
ooa
0Lf55
HdW
0t'
N3dV1
09
1N30NVl
'ONIOVdS 301A30
NOIll21l3NNVH0
+ss
'JNIOtldS
.x.
NOIS
•g
OW WafaLYM
I�oLLrJm nos
3nw3nxaan
vow 4
ONI 1N3W39MIN 31AJVH I
:A9 (130,138d N71d same aaawa
ueu)sopad lonAsgo )ou pegs pug ,94 x.gVjo wnwlulw a aq ueo ozls u61S •4 •�
•scum oyle4.9Z we saotnap 6ulzgauue40 •£ aN303i
•pa)eolpul aspmagt0 ssolun
3eap/4elaldwmagpegSsassaa6aPUB s)lxa's6emanup'sglemapls11V •Z -'—m t
1 3NIlHOlVW
•SP/epuels 33S 1H�JIN 1
SONOIN03 Jo 43 Pug uoinw 94) o) uuoluof 6upeds pug SU61S IIV '
:S910N •:I 1
l-OZM
tk06:t]
b14 ! Off¢
I 1
o �a
MS 7d H1061 F 3',` is r IS A883HO
® 9Z99tZ6(9Z61
wm'asd yonWey'•LIo6w6 lRo/8
;p
6taUClRa'da3 Na0 0
PPaH�6w0
�PSWad^S puwO glleil
A6�aa�Pw.Psta6Pd W20-1
gZ49.4Z4 (gZ4)
woo•asdr]o pooweg7No5aa6 t to L )aa4S
9LOZ 'Z 43LeW
VM'SONOW03 'NO M31A OldWAIO 1, M
99Z0t t60 wgor
AD83N3
Minos
136nd
i
133133S-- _ __ _ i__ _ 3NIlHOlVW
964
S6Z
i SZZ
i 99L
i'911
SL
iV
9L4
96Z
9OZ
0Sl
1 901
OL
Ot
94
04
I 5£
OE
SZ
OZ
sxaaM
S1Maa3dS 031SOd
3Nr
(laal) l= H10N3'1 i13dtl11Y0WINIYi
0
m
m
T::�i
N
'004 ,0ak 100�k
!a
7d 9YV39
O
a
N
O
ONE LANE C,
ROAD N
o nliEaD �
ROAD
WORK N
AHEAD
i
Puget Sound Energy Gas Pre -Inspect Form
Job #:
109110266
Date:
2/13/18
Jurisdiction:
Edmonds
ROW Permit:
Yes
Est. Start Date:
4/30/18
Est. Duration: 1-112 Days
Address: 19011 OLYMPIC VIEW DR
City/Zip: Edmonds, 98020
Customer: CHRIS MIONE 206 606-4870
PM / Inspector: Kevin Williams 426-691-7573
Job Description Scope of Work
From 4" STW main run complete altered service 1-1/4 PE(23' scat stub with 180' plat extension)
New Construction:
tie into existing
1-1/4 PE. C&C existing 1-1/4 service @ PL for future connection to new home.
No
Construction Method
Scat ROW / Plat Property
PLAT Map:
161.067
N
d 3
P/L
Blake PL I
I
r
L
�4@
w Fire Hydrant Crews will maintain min. 10' Seperation
h
P/L
Easement
I
I 1
l
to
N
G
m
6
o
1 1 '
1-1141, PE
I.,
31
I :.
a l
I ..
1-1
4" PE
�I
1
ij I
II
;l
1
i
_
ROW 60_ET
190th PL SW
Work Location
Size of Cut
Surface Type
10'
E
of CL
JOLYMPICVIEWDR
&
254'
1 N
I of CL
1190th PL SW
3x5
Asphalt
32'
E
of CL
OLYMPIC VIEW DR
&
204'
N
of CL
1190th PL SW
3x5
Grass/Dirt
of CL
&
of CL
Service Information
Street Information
Job Type
Diameter:
1-1/4" PE
Flaggers #:
Arterial:
Altered Residential Svc
EFV:
1-1/4" - 2600 - 9996744
Police #:
TCP:
Yes
Meter:
Speed Limit:
25
No Parks #:
6
PUGET
Meter Loc:
Trolley Lines:
Mtr Hoods #:
ENERGY
Del Press:
6" W.C.
Traffic Signal:
Bus Stop:
Bollards:
2.5" # 4--#T
ADA Ramps #:I
I Route #'s: