ROW PERMIT APPLICATION RECD 11-14-18.pdf
ROW PERMIT NO. : ENG___________
ISSUE DATE: ________________
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: CONTACT:
TvfTjejdl
21745:163
CONTRACTOR:Phone #:
QTF0Jogsbtpvsdf
536.568.7464
Mailing Address: Fax #:
2771QbslMbof-Cvsmjohupo-XB:9344
Email #:
State License #:
Tvtbo/TjejdlAqtf/dpn
JOGSBTM982D3
City Business License #: Liability Insurance Bonded
OS.136788
ADDRESS OR INTERSECTION OF CONSTRUCTION:
29922PmznqjdWjfxEs
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial Subdivision City Project Traffic Control (Only)
Multi-Family Single Family Other
EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? Yes I No
BLD#____________ ENG#____________
ANY ASSOCIATED PERMITS?
Xpslbsfbjtbqqspy25(Xup23(Fd0m
DESCRIPTION OF PROPOSED WORK (Be Specific) :
!pg!PmznqjdWjfxEsbmtp21(Td0mpgXibsgTu)2*4y6qbwjohdvuboujdjqbufeboe)2*4y6qbwjoh0hsbwfmdvuboujdjqbufe
_________________________________________________________________________
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES NO Year:
21745:163
46
PAVEMENT CUT: Yes NoIf yes, indicate size of cut: _________x_________
CONCRETE CUT: Yes NoIf yes, indicate size of cut: _________x_________
RIGHT-OF-WAYDURATION
AREATOTAL
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 anykind 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.
Ejhjubmmz!tjhofe!cz!Tvtbo!Tjejdl!
EO;!do>Tvtbo!Tjejdl-!p>Qfsnjuujoh!Efqbsunfou-!pv>Nvojdjqbm!
Sfmbujpot-!fnbjm>tvtbo/tjejdlAqtf/dpn-!d>VT!
Tvtbo!Tjejdl
2202503129
Ebuf;!3129/22/25!24;28;28!.19(11(
SIGNATURE DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Puget Sound Energy Gas Pre-Inspect Form
Job #:106349052
Date:Address:18811 OLYMPIC VIEW DR
9/24/18
Jurisdiction:EDMONDS City / Zip:EDMONDS, 98020
425-232-1812
ROW Permit:Yes Customer:SUSAN EMMONS
425-398-6192
Est. Start Date:1/21/18 PM / Inspector:
Kevin Williams
Est. Duration:1 Day (8 Hours)
Job Description / Scope of Work
New Construction:
From 2" PE main run new complete 1 1/8 PE service to single family home(42' scat stub with 80'
No
scat extension) set AL-425 meter OL @ Inches
Construction Method
All Scat / Trenchless
PLAT Map:161.067
N
R
E
W
E
S
R
E
T
A
W
SEWER
A425
1-1/8" PE
Gra
18811
ss
ROW 55'
Work LocationSize of CutSurface Type
WS
14'of CL Olympic View DR&10'of CL Wharf ST3x5Asphalt
ES
12'of CL Olympic View DR&10'of CL Wharf ST3x6Asphalt/Gravel
of CL&of CL
of CL&of CL
of CL&of CL
Service InformationStreet InformationJob Type
Diameter:1-1/8" PE Flaggers #:Arterial:New Residential Svc
EFV:1-1/8" - 2600 - 9999144 Police #:TCP:Yes Tie-In Fitting
254
Meter:A425 Speed Limit:No Parks #:
Meter Loc:04 - OL (rear)Trolley Lines:Mtr Hoods #:
Del Press:6" W.C.Traffic Signal:Bus Stop:
Bollards:2.5" #4" #ADA Ramps #:Route #'s:
JOB#
W
O
R
W
W
O
O
R
R
W
W
O
R
O
R
W
O
W
R
O
R
W
R
O
O
W
W
R
O
R
R
O
W
W
O
W
R
O
R
R
O
R
W
O
W
W
R
O
O
W
R
WR
O
O
W
R
R
O
R
W
O
WW
O
W
R
O
R
R
O
R
W
O
W
W
R
O
O
W
R
W
R
O
O
W
R
R
O
RW
O
WW
O
W
R
O
R
R
O
RW
O
W
W
R
O
O
W
RW
R
O
O
W
R
R
O
W
R
O
W
W
O
R
R
O
W
W
O
R
O
R
W
R
O
W
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
SIGN SPACING
W
MPH"X"
O
R
W
60/651000'
O
R
45/55500'
W
O 35/40350'
R
W
200'
30
O
R
25100'
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
CHANNELIZATION
DEVICE SPACING
MPHTAPERTANGENT
55/704080
35/453060
2040 ROWROW
25/30
JOB#
W
O
R
W
W
O
O
R
R
W
WO
OR
R
W
WO
R
O
R
W
R
O
O
W
W
R
O
R
R
O
W
W
O
W
R
O
R
R
O
R
W
O
W
W
R
O
O
W
R
WR
O
O
W
R
R
O
R
W
O
W
W
O
W
R
O
R
R
O
R
W
O
W
W
R
O
O
W
RW
R
O
O
W
R
R
O
R
W
O
WW
O
W
R
O
R
R
O
RW
O
W
RW
O
O
W
RW
R
O
O
W
R
R
O
W
R
O
W
W
O
R
R
O
W
W
RO
O
R
W
R
O
W
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
SIGN SPACING
R
W
MPH"X"
O
R
60/651000'
W
O
R
45/55500'
W
35/40350'
O
R
W 200'
30
O
R
25100'
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
W
O
R
CHANNELIZATION
W
O
DEVICE SPACING
R
W
O
R
MPHTAPERTANGENT
55/704080
35/453060
2040 ROWROW
25/30