JT-243030 ROW APPLICATION.pdfl� �OVEL&%p 0
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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
f'vcgg° PERMIT APPLICATION
Comcast - Cody Shackett
PROJECT NAME: 608 9th AVE S EM11 GEORGE CONTACT: Cablecom LLC - SUNSHINE CRABBS
CONTRACTOR: Cablecom LLC Phone #: 360) 454-3163
Mailing Address: 1316 Bonneville Ave. Bldg A Fax #• 360-836-3174
Snohomish, Wa 98290
State License #• CABLEL*971DP Email #• Comcast-waconstructionJointuse@cable.comcast.com
Cablecom LLC - sunshine. crabbs@cablecomllc.net
City Business License #: NR-021818 ® Liability Insurance ® Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 608 9TH AVE S
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑ Single Family
® EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
❑ Other
❑ Yes ® No
ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : REQUESTING PERMISSION TO REPLACE EXISTING
DAMAGED LINE. STARTING FROM PEDESTAL LOCATED ON WEST SIDE OF 9TH AVE S. SOUTH EAST CORNER OF 610 9TH AVE S PROPERTY
LINE, REPLACE EXISTING PED WITH NEW PED, FROM NEW PED BORE, PLACING NEW 1, 2" CONDUIT AND NEW .625 COAX, HEADING NORTH
APPRX. 1 01'THEN WEST APPROX. 5' TO PRIVATE PROPERTY. ALL UTILITIES TO BE LOCATED PRIOR TO CONSTRUCTION. JOB# 243030
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year:
PAVEMENT CUT: ❑ Yes ® No If yes, indicate size of cut: x
CONCRETE CUT: ® Yes ElNo If yes, indicate size of cut: 3 x 3
RIGHT-OF-WAY
AREA
CLOSURE
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.
SIGNATURE DATE 6/09/2017
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE