ROW permit application.pdfOf F-DA,104"
INC,— 90
ROW PERMIT NO..
ISSUE DATE-.
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RIGI�H'I'-OF������-W.,AY'"CONS'YRU('.1 ION
PERMIAPPLICATION'
PROJECTNAME: Jacobsen's Marine
CONTRACTOR.' SeaCon. LLC
Mailing Address: 165 NE Jun.J.per St.
State License o.
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City Business License N: NR -01. . ..9.019
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CONTACT- Ran 'rurner
Fnx #:
425.837.158S
Email #.- rtux-ner@seaconllc.com
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iability Insurance "lome
AIDI)RESSORIN'I'ERSECT'IONOR' ONSI'RIJC'T'ION: 3445 Admiral Way
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF'PROJECT:
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7;�ff T ---- 11- ........ . . . ... . ............ -
ubdivision ntrol (Only) o, a -i- - -- —S ------------
----- — --------- --- - 11 -
Muld-Finfll Single Family r] Other
El EUC (PUD, VERIZON, PSE,
'fib CAST, OV -%VSD):
Is this permit part ofa blanket pen -nit? Yes No
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DESCRIPTION OF PROPOSED WORK (Be Specific) - New 10,120 SF boats sal.es
and repair shop.
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PAVEMENT T.- 0 ves El No
CONCru,m CM": Yes No
If yes, indicate size (if cut:
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If yes, indicate size of cut- —K
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 undersfnd the permit requirements and acknowledge that I must
follow all requirements in order f(vAhe lit to be valid.
SIGNATURE °� DATE ///Z
a etor or Ag