TCP-ENG20160295.pdfX
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Job -1587799 —street view
showing location of wire box
at 220 St SW & Hwy -99
Ig"U" mvo
. 1 '90
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION RECEIVR)
PROJECT NAME: 1719903
CONTRACTOR: Puget Sound Energy -Corrosion
Mailing Address: 6500 Ursula PI S, Seattle WA -98108
State License #: PUGETSE032,11
City Business License #:
CONTACT: Betty Frank ,JUIV 2 2 2016
Phone #: 206-716-2641
Fax #:
Email #: beay.frank@pse.com
F-1 Liability Insurance [9 Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 22001 Hwy -99
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
R Commercial El Subdivision LJ City Project * Traffic Control (Only)
F] Multi -Family E] Single Family
FE EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
F1 Other
F-1 Yes MR No
� ANY ASSOCIATED PERMITS? I � BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific): Location of work: 220 St SW & Hwy -99. _
Work Description: Perform yearly maintenance and get read at test lead wire box located at 26'Scl 220 St SW
& 57'Ecl Hwy -99. Lane closure - Eastbound lane of 220 St SW. Just need to enter ROW to inspect equipment.
Duration of work: approx 10 mins.
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES E] NO N Year:
PAVEMENT CUT: F-1 Yes FEI No If yes, indicate size of cut: x
CONCRETE CUT: F-1 Yes FE] No If yes, indicate size of cut: x
AREA
[:RIGHT-OF-WAY
CLOSURE
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF
X
LF
SF
N/A
Alley 72 Hrs + LF
X
JLF
N/A
Larking 72 Hrs + LF
X
]S]F
N/A
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 6/17/16
Contractor or Agent
NO WORD SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Permit Number: EN G20140618
Job Address: 22001 HIGHWAY 99,.EDMONDS
INFRASOURCE CONST -PSE
13330 STONE AVE N
SEATTLE, WA 98133
220th St Sw & Hwy 99. Perform yearly maintenance and g,
99. Lane closure of 220th St. SW. Just need to enter ROW
ASSESSED VALUE:
$0,00 PROPER
A
SIDEWALK: (OXO)
DURATION IN MONTHS:
0
PARKING: ( 0X0
DURATION IN MONTHS:
ALLEY: I 0X0
DURATION IN MONTHS
INDEMNITY- The Applic
damages or claims of any
any of its departments
attorney fees by reaso o
THE C 0 NTRA S RE
INSPECTION AN CCEP
i P
INFRA RCE COP
13330 0 E AVE
SEA , L Ej,A 9 81
(206 9-5 6
r/�ate :tl0642/2015-'
Location:
EXP: 02/14/2015
at tes, adV Xbo' location 26'Scl of 220th St SW & 57 Eel Hwy
ti
neat eq tion of work approx 10 min.
FEE: $ STREET DISRUPTION TRENCH CUT: ( 0 X 0
0 FEE: $0.00
.0
00
FEE. . 0 YEAR OF OVERLAY:
'$0
, 00
i�Efl '$0 00
?s he/she holds the City of Edmonds harmless from injuries,
or unforeseen, that may be made against the City of Edmonds or
e defense ofany legal proceedings including defense costs and
SIBLE�tFW SHIP AND MATERIALS FOR A PERIOD OFONEYEAR FOLLOWING THE FINAL
V
EOF W
b lic s /afet hall b 'accordance with City regulations as required by the City Engineer. Every flagger must
by (WA y 296- -305 and must have certification verifying completion of the required training in their
c or nce th City codes, All street -cut trench work shall be patched with asphalt or City approved
w
I. e n /day- NO EXCEPTIONS,
gs of proposed
't' ngs of proposed work are required with the permit application.
,LL DIAIA-DIG (1-800-424-5555) BEFOREANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REQ IJESTS
IMISAPPLICATION ISN A PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED. Printed: Wednesday, December 17, 2014
3
[� FILECOPY P INSPECTORCOPY F.] APPLICANT COPY
STATUS: ISSUED ENG20140618
• Sound/Noiseoriginating from temporary construction sites as a result of construction activity are exempt from the noise limits
of ECC Chapter 5,30 only during the hours of 9:00am to 3:00pm on weekdays and 10:00am and 6:00pm on Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originating from construction s ites/activities must comply with the
noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30,120,
• Restore ROW to City standards
• Alert affected residents and/or businesses prior to work start.
• Conform to approved working drawings and Traffic Control plan.
• Utility patch restoration to be in accordance with Edmonds Standard detail E23
• Maintain erosion & sedimentation control. Keep street clean.
• Call for required inspections as noted.
• Traffic Control per approved plan and MUTCD. Refer to City of Edmonds traffic control requirements.
• Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way per City standards that is
caused by or occurs during the permitted project.
• Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance not limit in any way the City's ability to enforce any ordinance
provision.
Ell
• E -Traffic Control
• EEngineering Final
PARTIAL INSPECTION DATE: INITIAL: NOTES:.
PARTIAL INSPECTION DATE- INITIAL: NOTES;
FINAL INSPECTION APPROVED DATE: INITIAL: