ROW PERMIT APPLICATION.pdfOo(noic_ \J�w Nwi5%oc'�
PROJECT NAME: K5�LA
CONTRACTOR:
... ... .......
MailingAddress: 11a "w c1c .. eveaGrT
WA
State License
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City Business License #: NPL-0154 Iq
I MGM 92 N0
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CONTACT: cue.
(Wp) 300-3olg
lRuability Insurance Ro'd 4
ADDRESS OR INTERSECTION OF CONSTRUCTION: 167 VA DP.;-f-
Commercial
F] Multi -Family
Subdivision
RJ Single Family
F EUC (PUD, VE RIZON, PSE,
CONICAST, OVWSD):
Is this pen -nit part of a blanket permit?
City Project
F1 Other
ANY ASSOCIATED PERMITS? BLD# ENG#
Traffic Control (Only)
DESCRIPTION OF PROPOSED WORK (Be Specific): k3k)Aj AS&4e1tr 13 3 T th ' L n5j+;Q%
(rUHLU�a DaAWF��. (3-s:oge fe"3 *6m we- 4'ki A
C4:-- r-. 7. 9 4:6-Q- SAfGTLN- k1A Q0Qm,,%4HA(,, 0. c9Rt_LAAf C_�5L4trt &'o
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I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES [:] NO 9 Y
PAVEMENT CUT:
CONCRETE CUT:
F] Yes F] No If yes, indicate size of cut: - X
F-1 Yes �9 No If yes, indicate size of cut: x
RIGHT-OF-WAY DURATION
AREA TOTAL
CLOSURE (NUMBER OF MONTHS)
F :E AY
W 'U
Sidewalk 48 Hrs + LF X LF SF L
. . ............... . . . . . . ............... . . . -
Alley 72 Hrs + LF X LF SF
..........
Parking 72 Hrs + LF XLLF 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 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 qrder for tke/permit to be valid.
01UNTEVO M,
(f DATE /Y
r or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Date Prepared. 9/17/2018
C�E Date Scheduled: Olympic View Neighbor's
Quahly Asphalt Paving, Sealcoating, Striping, Concrete, Curbing QUOTE Revised
12322 lfighwa� 99 S, Suite 126 * Everelt, Wash. ()8204-8547 Proposal # 184043
Telephone 425-355-2474 * Fax 425-355-5499 Job #
Cont. I IiC r t; NYSENP l 07D6
Contact Name: Stephen Gregory Management: Gregory D40 & Company
JOB Address: 18719 Olympic View Drive Address:
Edmonds, WA
Work Phone: (206) 442-7615 Phone:
E-Mail: Stow �reor_yjaICLWM Fax.,
Description: bpopn Inspection of the Existing Driveway - I Have Created a Custom Paving Package
to Include Everybody's Driv,-way +Alternate Add -On Options& Priced this as a
6.69up Pricing Package "r I have also listed the Price to Pave each Area Independently
as to Provide everyone with Sepel-ated Cost for Kour Convienence-
Group Paving package C,-b,-,,,d C,-ptt, overlay.
Asphalt Repairs: (3_)Area's- Approx6,180' Sci Ft- (All Existing Asphalt from Street )To Ovcrlay._.Aiih2jof HMA
includes Area's on Map: [ opt. A + opt B + opt. C I
Cut & Remove Area's For Transitions ( Key-Way's
Cut and Remove Sunken Asphalt + I Area of Mlnor Roots, & Haul Away Broken,
Pre -Level Removed Area's with Fresh Hot Mix Asphalt & Compact.
Clean Existing Surfaces & Apply Tack Coat for Asphalt Adhesion
Pave All with 2" of Hot Mix Asphalt - Class B modified. Roll -Compact & Seal Edges.
- RePlace Up to 30' LF of Water Berms .
I Alternates
Revised
.AREA [ D
Includes NO MOBILIZATION INCLUDED - ADD ON to EXISTING MOB.
- Remove Up to 5" of Existing Rock -as necessary for elevations after overlay.
- Add 2" of Fresh Crushed Rock ( 5/8"s Minus Chipped) Fine Grade & Compact,
*AREA ( F 1,
Includes NO MOBILIZATION INCLUDED - ADD ON to EXISTING MOB,
- Remove Up to 4" of Existing Dirt/Grass/ Rock - Haul Away
- Add 2" of Fresh Crushed Rock (5/8"s Minus Chipped) - Fine Grade & Compact,
NOTE This Price Does Not Include Traffic Control, Flag ers and Signs may be needed @
an Additional Cost
TOTAL QUOTE
(Does not include sales tax)
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