ROW Permit Application.pdf-1 O v >r. C A111„1.
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ROW PERMIT NO.: ENG i 617
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: PLN20150007 (Mueller SP) CONTACT: Todd Echelbarger
CONTRACTOR: Echelbarger Investments, LLC Phone #: 425.673.1100
Mailing Address: 4001 198th St. SW. #2 Lynnwood, y d, 98026 Fax #:
State License #• ECHELIL90 Todd@E
� Sd6.....� .. Email #• �.�
• helbarger.com
City Business License #• 010390
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x Liability Insurance ❑x Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 3rd avenue & Caspers street
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial Subdivision E] City Project Traffic Control (Only)
❑ Multi -Family ® Single Family 0 Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes ❑ No
ANY ASSOCIATED PERMITS? i'' "0 2�,�i ..:_007 ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) hisW1 tit o'V'iti access road drair�ua's
and other improvements as depicted on the approved Mueller Short vlat construction plans.
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WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? . YES I NO Exxj' Year:
PAVEMENT CUT: 0 Yes ❑ No If yes, indicate size of cut: __x
CONCRETE CUT: E Yes ❑ No If yes, indicate size of cut: x
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 in order for the permit to be valid.
SIGNATURE DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE