REV ROW APP Rec'd 11.4.19.pdf'rAfC. 1 v-13
ROW PERMIT NO.: ENG
r V�• DATE:
® R ,
PERMIT
,R APPLICATION
PaO
PROJECT NAME: �V�O CONTACT:
1
CONTRACTOR:y Phone #: Lk I S-
Mailing Address:�o OX ` Fax #:
&ate44eeWe #:G.V . W k . ` %J0( Email #•
City Business License #: El Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: ` O \ d':!�,
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project K Traffic Control (Only)
❑ MuIti-Family ❑ Single Family ❑ Other
EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is.this permit part of a blanket permit? ❑ Yes, U No
ANY ASSOCIATED PERMITS? BLD# ENG#
" DESCRIPTION OF PROPOSED WORK, (Be S1
4
WAS STREET OVERLAYED WITHIN THE LAST FIVE ! ' YEARS? YES ❑ NO.[] Year:
PAVEMENT CUT: ❑ Yes Vo No If yes, indicate size of cut:. x
CONCRETE CUT: ❑ 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 SF
Parking 72 Hrs + LF X LF SF
AA.PPLICANT TO READ AND SIGN
47raffic 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 helshe 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 S
on actor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
ROAD
ONSTRUCTI>(W2
aHEAD
') SEE NOTE 1
ROAD
NARROWS
(W5-9
3o SEE NOTE i
TAPER LENGTH
(TABLE A) -
TABLE A
TAPER
LENGTH
SPEET.
(FT)
CONE SPACING
(MPH)
JOFFSET
WIDTH
ALONG TAPER
10'
(FT)
25
100
25
30
150"
g540
30
35
200
35
40
270
40
'45
450
45
NOTE:
1. DISTANCE. BETWEEN SIGNS SHALL
BE 100' FOR RESIDENTIAL
STREETS (25 MPH), AND
206' FOR ARTERIAL ROADWAYS
2. FLASHING BEACON SHALL BE
INSTALLED' AT EACH SIGN FOR
NIGHT—TIME- USE.
.3. DISTANCES MAY VARY AS APPROVED
BY THE ENGINEER.
4. .FLAGGERS REQUIRED TO CONTROL
TRAFFIC WHENEVER THE CONTRACTOR
MUST INTERRUPT TRAFFIC FLOW
TO ACCESS THE WORK SITE WITH
MATERIALS OR EQUIPMENT.
LEGEND:
O: CONE OR' CHANNEL'IZING DEVICE
3 (SEE STD 7-14)
19 -
i
WORK AREA
]L]I
—TRUCK WITH
FLASHING OR WITH
BEACON
' 30C
I
TAPER LENGTH
(TABLE A)
1 -
T.
SEE NOTE 1
(Wl-4 Q
SEE NOTE 1 30
ROAD
NSTRUCTION
AHEAD
(V20-1)
10'
tt. TRAFFIC: CONTROL PLAN
+':;,,_ • 2 LANE ROADWAY PARTIAL LANE CLOSURE - ' :
PUBLIC UTILITY DISTRICT NO.1 OF SNOHOMISH COUNTY
LOCATION 18103 HOEMVIEW DR ED LYNNAREA
POLE No. 188927 NW1/4S 17 T 27 R 04 DATE 7/15/19 ORDER 100048784
REASON FOR WORK REPLACE 121 80 POLES FOR PUD ENGINEER MCALLISTER OPERATION 30
DRAFTER U.G. NO.
SCALE
APPROVED
& DATE PRINTED
DATE WORK COMPLETED
FOREMAN
FEES REQ'D ❑ YES
PRIMARY OVERHEAD
❑ RESIDENTIAL
❑ COMMERCIAL
LEO NO.
'@$ -S
ENG AS -BUILT VERIFICATION DATE
❑ PHASING, TAPS & FUSING SUBSTATION PRV
❑ POLE & VAULT STENCILS
■ NO ❑ CABLE TAGS CIRCUIT NO. 93 PHASE 3
❑ FRAMING
❑ EQUIPMENT LOCATION
VERIFIED BY
DATE
SECONDARY OVERHEAD
NESC VIOLATIONS
BASIC FEE S
❑ NO ❑ YES (SEE NOTES)
Q9 '=9
PERMITS (DATE GRANTED)
❑ TREE TRIM
❑ STATE
METER/CONV. POLE S
PRIMARY UNDERGROUND
❑ RESIDENTIAL
❑ COUNTY
❑ COMMERCIAL
■ CITY
BASIC FEE S
❑
EASEMENTS
LEU NO.
@� 1=3
❑ REQUIRED ■ NOT REQUIRED
SECONDARY UNDERGROUND
BASIC FEE S
DATE RELEASED
@$ ._$
UNDERGROUND PLAT
FOREIGN CONTACTS
■ JPN#
BASIC FEE S
FT.@$ =g
❑ JOINT TRENCH FRONTIER & CATV
❑ JOINT BORE FRONTIER & CATV
STREET LIGHTING
FT.0 '=s
❑
POLE STENCILING
WORK IN RIGHT OF WAY
FROM TO
❑ PRIMARY
TAKE OFF POLE
❑ SECONDARY
PRE-CONST. REQUIRMENTS
❑ TREE TRIM ❑ PUD LOCATOR
ri FT.0 =g
MISCELLANEOUS FEES
❑ BACKHOE ❑ FLAGGING
VAULT S
■ ONE CALL DATE
PERMIT S
No.
STREET LIGHTING
■ YES ❑ NO
$
S
S
M&R
AS -BUILT
S 0
GIS
TOTAL DUE S
GIS QC
M&R
DATE PAID
GIS Ph
JOINT USE
RECEIPT NO.
SERVICE ORDER NO.
LOCATION MAP PAGE 455 A2
!Irdq!d\ az
O EXISTING POLE
X EXISTING POLE -TO BE REMOVED
• NEW POLE
NEW POLE TO REPLACE EXISTING POLE
ENGR'S TEL. #
425-670-3216
ENGR'S CELL #
425-501-1254
N
• . 1 1 • (1 • ., J
OF FIRE HYDRANT AS STAKED
FRAME PER ASSY 12V1019 12V601 AND 12V113
INSTL NEW D.G. AND AHR L=10'
XFR [11 PRI AND [1] NEUT
XFR DIST XFMR 015-17933
SEC VOLT / SER#
OB POLE 8373
REPLACE 45' POLE 10' E OF EDGE OF PAYMENT AS STAKEDI
FRAME PER ASSY 12V102
INSTL NEW D.G. AND AHR L=10'
PRV F
93
L\
-
SL-130281-A
15-ll933
SHEET OF