Permit & App.pdfEv u, �i
t,,ITY M ND'
121 5THAVENUENORTH-EDMONDS, WA 98020
t„ PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20160423
PERMIT -------------
RIGHT OF WAY
Permit Number: ENG20160423 Expiration Date: 06/30/2018
Job Address: 19011 OLYMPIC VIEW DR, EDMONDS Location:
CHRISTOPHER A & MERIN L MIONE tbd
19011 OLYMPIC VIEW DR
EDMONDS, WA 98020-2354
LICENSE 4 EXP;
JOB DESCRIPTION
Install driveway approach and water service connection„
DISRUPTION1
ASSE SSE ) VAI,tJE: $0.00 PROPERTY AREA ; 0
SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0.00 s;T REET DISRUPTION TRENCII CUT: ( 0 x 0 )
PAIRK[NGr ( Ox0) DURATION IN MONTHS O FEE: S0.00 YEAR OF OVERLAY: 0 FEE; $0,00
ALLEY: t OX0 I®iJRA.TION IN M01\T]] 0 FEE; S000
1NDEMIWTY 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.
THECONTRACTOR 1S RESPONSIBLEFOR WORKMANSHIP AND MATERIALS FOR A PERIOD OFONEYEAR FOLLOWING THEHNAL
INSPECTION AND ACCEPTANCE OF THEAO'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 pen -nit application.
(!ALI, l I A l l I It t 1� 5 5j 1 EFOREANNY%" CIt TA"I"I4 P4
[CA LL 1 O INSPECTION (425)771 0220 EXT. 1326
24 HOUR NOTTCEREQUIRED FOR ALL INSPECTION REQUESTS
'MISAPPLICATION IS NOTA PERMITUNTCL SIGNED BY THE CITY ENGfNEE:R ORHISMER DEPUTY: AND FEES ARE PAID, A ND REC tIPTES ACKNOWLEDGED IN
SPACE PROVIDED
RELEASED BY
Printed: Wed]tcA ,April 1 8,2018
qh Ph
DATE
❑ FILE COPY ❑ INSPECTOR COPY ❑ APPLICANT COPY
STATUS: ISSUED
ENG20160423
• 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.
o Public utilities maintain 5' separation from City Utilities.
• Verify clear bore crossings
r 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 from temporary construction sites as a result of construction activity are exempt from the noise limits
ofECC 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 of this 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.
INSPECTIONS
• &Erosion Control/Mobilization
• E-Traffic Control
• &Driveway Approach
• E-Pavement Compaction Report
• E Water Service Trench Restoration
• E Engineering Final
PARTIAL INSPECTION DATE:..MITIA L. NOTES:
PARTIAL INSPECTION DATE: ..............................�.�.�.�.�.�.�.�......�......... INITIALS: �.�.�.�.�.....�.� NOTES:.........................................................�666...6 _.
FINAL INSPECTION APPROVED DATE: INITIAL..,:
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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: CONTACT:
. . ..... e o' L
CONTRACTOR: S �rdl Phone #: `7
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Mailing Address: 7C) 13 cr,< (D %'k'
\,A)� Fax #:
State License Email #: U Kv ((A'
City Business License #: -2 rS c-6 F1 Liability Insurance L] Bonded
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ADDRESS OR INTERSECTION OF CONSTRUCTION:
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial
F] Multi -Family
Subdivision
0 Single Family
F1 EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
City Project
F] Other
El Yes F-1 No
Traffic Control (Only)
ANY ASSOCIATED PERM1TS? BLD# www www
-- - --- - -------- — ENG#-1
-PN 7_101(f 00-7's_
DESCRIPTION OF PROPOSED WORK (Be Specific):
WAS ----STREET ---- -O-VERLAYED WITHIN THE LAST FIVE (5) YEARS? YES [I NO [I Year:
PAVEMENT CUT:
CONCRETE CUT:
11 Yes F1 No
El Yes El No
If yes, indicate size of cut:
If yes, indicate size of cut:
x
x
RIGHT-OF-WAY DURATION
AREA TOTAL
CLOSURE (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 ` ord - for 01 11it to ' etvalid.
SIGNATURE
�. DATE
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE