Issued Permit ENG20190211.pdfLam, Oti CY OWN
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
C. I
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20190211
RIGHT OF WAY PERMIT
Permit Number: ENG20190211 Expiration Date: 11 /17/2019
Job Address: 21328 84TH AVE W, EDMONDS Location: 21328 84th Ave W.
PSF/Infi as ounce
P SE/Infrasource
CIO Susan att: Sidick
C/O Susan att: Sidick
1660 Park Lane
1660 Park Lane
Burlington, WA 98233
Burlington, WA 98233
(425)457-6353
LICENSE #: infrasl87lc2 EXP: 02/22/2019
Final restoration of previously installed gas line. Previous work completed under ENG20120434. Work to be completed prior to City of
Edmonds grind and overlay of 84th Ave West, currently scheduled for the 1st week of July 2019.
DISRLIPTION INFORMATION
ASSESSED 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 which 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 ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONEYEAR FOLLOWING THEFINAL
INSPECTION AND ACCEPTANCE OF THE W ORK.
• 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 of the 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 NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
THIS APPLICATION IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER ORHIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Friday. Mav 17.201
FILE COPY INS PECTOR COPY APPLICANT COPY
STATUS: ISSUED
ENG20190211
• 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 repair/replace all damage to utilities or frontage improvements in City right-of-way per City standards that is
caused by or occurs during the permitted project.
• Sound/Noise originating fromtemporary construction sites as a result of construction activity are exempt fromthe noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 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.
• E Traffic Control
• E-Curb/Gutter Pre -Pour
• E-Engineering Final
• E-Curb/Gutter Post -Pour
PARTIAL INSPECTION DATE. INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
0f EDAg04/
INC. 1.390
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGI I T-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 109076212
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871 C2
City Business License #: NR-019840
CONTACT: Susan Sidick
Phone #: 425-457-6353
Fax #:
Email #: susan.sidick@pse.com
❑ Liability Insurance 0 Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 21324 84th AVE W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project El Traffic Control (Only)
❑ Multi -Family ❑ Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes ❑* No
I ANY ASSOCIATED PERMITS? 1 BLD#
ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : Work anticipated is for finale restoration
previoulsy under permit # Eng20120434 I5' N c/I of 214th PL SW
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES F1 NO 0 Year:
PAVEMENT CUT: [J Yes ❑ No If yes, indicate size of cut: _ 3 x 5
CONCRETE CUT: 0 Yes ❑ No If yes, indicate size of cut: x
RIGHT-OF-WAY
DURATION
CLOSURE AREA
TOTAL
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF
X
LF
SF
Alley 72 Hrs + LF
X
LF
LF
SF
Parking 72 Hrs + LF
X
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 05/17/2010
SIGNATURE
DATE
Contractor or Agent
NO WORD SHALL BEGIN PRIOR TO PERMIT ISSUANCE
� OY3HY
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r ght-of-Yvay per Ci*t � standards that is c
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214TH PL SW
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A 0 UANTA SERVICES COMPANY
Job#109076212
21328 84th Ave W, Edmonds, WA
September 12, 2012
Sheet 1 of 1 greg.harwood@pse.com
(206) 418-4217
0c:
SD —I F- SV
214TH PL SW—
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to Gfv CAP Kv I� INXIO L -r0 Cl-Tq &amj
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ns and spacing to conform to the MUTCD �r
of Edmonds standards.
dewalks, driveways, exits and egresses shall be
ely clear unless otherwise indicated,
nellzing devices are 28" traffic cones.
size can be a minimum of 36" x 36" and shall not
pedestrian access.
Is reoulrAd tn INAVa a minim ��` �ttCfk. V te-
f DMOK)N
NOTE
1
' PUGET
SOUND
ENERGY
PAVING
REQUEST
TICKET: 5075907
PERMIT:
SHEET: I OF
ADDRESS: 2 l f XC S, kJ . d- 8 Li + �l J L✓.
CHECK: CITY: REQUESTED BY/
MINSIDE ❑ OUTSIDE V �L� S [IPOTELCO E; PASOURCE ❑ PSE
DRAW LOCATION OF CUT AND NUMBER IT ACCORDINGLY:
-----
r_
N N
MATCH #
FROM DRAWING
ABOVE
TYPE
(SEE KEY
BELOW)
SIZE
(CALLED
OUT)
DEPTH
IN INCHES
LOCATION
SIZE
(ACTUAL
INSTALLED)
Example 1
A
2 X 8
8"
25' N CIL Test St
AA to complete
r
ern
��' rJ-C-L �� 21 Yfs pe._S •
ly
y X
�•
I� , ,
SAP ORDER NUMBER: Yo 7 O7-& Z %
LOCATE NUMBER:
SAP NOTIFICATION NUMBER:
DATE HOLE CLOSED: 0S " / Y — f
PM/PERSON RESPONSIBLE:
DATE AA RECEIVED:
,► / lS
_
1 V FORM FILLED OUT BY: _ ! Gl�
AA LOCATE NUMBER:
YEV
NO
KEY
TRAFFIC CONTROL
❑
C =,,
CONCRETE IN STREET OR ALLEY (INCLUDING CURS AND GUTTER)
POLICE OFFICER
❑
ej
C/WC =
CONCRETE WHEEL CHAIR RAMP
PLATE OVER HOLE
❑
j�
C/SW =
CONCRETE SIDEWALK, DRIVEWAY APPROACH ,
NO PARKS
❑
(INCLUDING CURBANDGUTTER)'
SHALLOW UTILITIES (LESS THAN 1e-)
[�
C/G =
CONCRETE CURB OR GUTTER
IN RIGHT OF WAY
A =
ASPHALT
PRIVATE PROPERTY
❑
if
A/C =
ASPHALT OVER CONCRETE
UNDER TROLLEY LINES
❑
0
G/O =
ASPHALT GRIND AND OVERLAY
FINAL TICKET FOR THIS JOB
❑
call
V =
VALVE (RAISE VALVE AND REPAVE)
EXTRAORDINARY NCC (OFFICE usE)
❑
❑/
B =
BRICK (COBBLESTONE)
r
M =
MISC (STRIPE, GRADING, ETC.)
1967 02/14
4PUGET
SOUND
ENERGY
PAVING
REQUEST
ADDRESS:
ZI It 45 Pc.
CHECK: CITY: �^
INSIDE ❑ OUTSIDE G i, M D'i b S
DRAW LOCATION OF CUT AND NUMBER IT ACCORDINGLY
TICKET: 5075908
PERMIT:
SHEET: OF
REQUESTED BY:
❑ POTELCO L?INFRASOURCE ❑ PSE
pLI44
Q
1
N
MATCH #
FROM DRAWING
ABOVE
TYPE
(SEE KEY
BELOW)
SIZE
(CALLED
OUT)
DEPTH
IN INCHES
LOCATION
SIZE
(ACTUAL
INSTALLED)
Example 1
A
22 X 8
W
25' N CCIL Test St
AA to complete
01
c [� K
SAP ORDER NUMBER: 10 r O 1-
SAP NOTIFICATION NUMBER: _
PM/PERSON RESPONSIBLE:
FORM FILLED OUT BY: /jf (' /,G fS
LOCATE NUMBER:
DATE HOLE CLOSED: '25- - i Y —,f
DATE AA RECEIVED:
AA LOCATE NUMBER:
YES
NO
KEY
TRAFFIC CONTROL
(�
❑
C =
CONCRETE IN STREET OR ALLEYONCLUDINGcuRB AND GUTTER)
POLICE OFFICER
❑
C/WC =
CONCRETE WHEEL CHAIR RAMP
PLATE OVER HOLE
❑
[�
C/SW:=
CONCRETE SIDEWALK, DRIVEWAY APPROACH
NO PARKS
❑
)INCLUDING CURB AND GUTTER)
SHALLOW UTILITIES (LESS THANie-) ..
C/G =
CONCRETE CURB OR GUTTER
IN RIGHT OF WAY
A =
ASPHALT
PRIVATE PROPERTY
❑
A/C =
ASPHALT OVER CONCRETE
UNDER TROLLEY LINES
G/O =
ASPHALT GRIND AND OVERLAY
FINAL TICKET FOR THIS JOB
V =
VALVE (RAISE VALVE AND REPAVE
EXTRAORDINARY NCC (OFFICE USE)
❑
Ir�d/
B =
BRICK (COBBLESTONE)
M =
MISC (STRIPE, GRADING, ETC.)
1967 02/14
Al pf EUAs�ti
Y CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20120434
RIGHT
Permit Number: ENG20120434 Expiration Date: 2/28/2013
Job Address: 21328 84TH AVE W. EDMONDS Location:
CONTRACTORAPPLICANT
INFRASOURCE CONST-PSE INFRASOURCE CONST-PSE
13330 STONE AVE N 13330 STONE AVE N
SEATTLE, WA 98133 SEATTLE, WA 98133
(206) 949-5846
LICENSE #: INFRACL899CZ EXP: 2/14/2013
• i DESCRIPTION
Occupying N & S bound lane of 84th Ave W bound lane of 214th Pt SW to install approx 60' of T PE IP gas main. 3 (3x5) cuts
anticipated.
W O# 109076212
DISRUPTION• •
ASSESSED VALUE: $0.00 PROPERTY AREA: 0
SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0.00 STREET DISRUPTION TRENCH CUT: (O X 0 )
PARKING: ( OXO ) DURATION IN MONTHS: 0 FEE: $0.00 YEAR OF OVERLAY: 0 FEE: $0.00
ALLEY: I OXO I DURATION IN MONTHS: 0 FEE: $0.00
INDEMNITY: The Applicant has signed an application which states he/she holds 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 but not limited to the defense of any legal proceedings including defense costs and
attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKAfANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK,
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) 29&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 of the workday- NO EXCEPTIONS.
Three sets of consuuctiun drawings of proposed work arc. 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 NOTICE REQUIRED FOR ALL INSPECTION REQUESTS
APPLICATIONPP•
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Wednesday, November 28, 2012
RELEASED BY nATF
FILE COPY INSPECTOR COPY �4�]-.APPLICANT COPY
-i OF EL)A40 'O
-'Arc, z S 9 0
�I-P. Cis .A ti�
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERY1IT APPLICATION
PROJECT NAME: `77 V
CONTRACTOR: J Y7 fAT �D a ( r.G
Mailing Address: 1 z 1111
State License #: I N F �_ A 0 _ e? 1I
City Business License #: N P- 0 )
CONTACT L'
Phone #: GCS l� �i� �i _r27J4 b
Fax #:
Email "Am
r(/ I -c , L% J/7 /' y - or)`
lability Insurance LJ Bonded
ADDRESS OR ]INTERSECTION OF CONSTRUCTION: 2 Q P� Av (' Y .
ROW WORK ASSOCIATED WITH THE FOLLONq NG TYPE OF PROTELJ
CT:
Commercial Subdivision City Project Traffic Control (Only)
❑ Multi -Family ❑ Single Family ❑ Other
EUC (PUD, VERIZON, SE
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes ❑ No
ANY ASSOCIATED PERMITS BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : 7 I /4rM I0 06/
SIN TO 11'�r77
WAS STREET 0VERLAYED WITHIN THE LAST FIVE YEARS? YES NO Year:
PAVEMENT CUT:
CONCRETE CUT:
[Yes ❑ No
❑ Yes ❑ No
If yes, indicate size of cut: �J x
If yes, indicate size of cut: x