ENG2020-0270OF WAY EUC PERMIT
PERMIT NUMBER
City of Edmonds
AveRIGHT
9801 1 1 1
www.cityofedmonds.gov
Description: PSE REPLACE GAS SERVICE ISSUED: 10/09/2020
Address: 20927 81ST PL W EDMONDS WA 98026-7019
EXPIRES: 10/09/2021
it Type: RIGHT OF WAY EUC Permit Subtype: MINOR Parcel Number: 00561200000700
I 11-14111 a
W
NAME TYPE NAME ADDRESS PHONE
APPLICANT PSE/INFRASOURCE 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353
CONTRACTOR PSE/INFRASOURCE 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353
OWNER KARR MICHAEL 20927 81ST PL W, EDMONDS WA 98020
FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE CHARGED PER PERMIT
$40.00 $0.00
ENGINEERING INSPECTION FEE
$110.00 $0.00
RIGHT OF WAY MINOR - EUC PERMIT FEE
$110.00 $0.00
•
REQUIREMENT TYPE
NOTES
TRAFFIC CONTROL 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 posession.
RESTORATION Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with
asphalt or City approved material prior to the end of the workday - No Exceptions
WARRANTY The contractor is responsible for workmanship and materials for a period of one year following the final
inspection and acceptance of the work.
INSPECTION SCHEDULING: WWW.MYBUILDING PERMIT.COM
24 HR NOTICE REQUIRED
INDEMNITY
The Applicant has signed an application which states he/she holds 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 but not limited to the defense of any legal proceedings including defense costs and attorney fees by reason of
granting this permit.
RELEASED BY
THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW
DATE
Printed: Friday, October 09, 2020 1:06:16 PM 1 of 2
-KRWOF WAY EUC PERMIT
PERMIT NUMBER
City of • • •
www.cityofedmonds. ov/425.771.0220
CONDITIONS
CONDITION TYPE
Easement and/or permission from adjacent property owner is required prior to entry or work within
ADJACENT PROPERTY
an adjacent property.
Contractor/Owner shall be responsible for repair/replacement of all damage to utilities and/or
DAMAGE TO FRONTAGE
frontage improvements in city right of way per city standards that is caused by or occurs during the
IMPROVEMENTS
permitted project.
ALERT AFFECTED RESIDENTS AND/OR BUSINESSES PRIOR TO WORK START.
VERIFY CLEAR BORE CROSSINGS.
ENGINEERING OTHER
RESTORE LANDSCAPE TO LIKE OR BETTER CONDITIONS.
CALL FOR REQUIRED INSPECTIONS AS NOTED.
ESC REQUIRED
Maintain erosion & sediment control per city standards.
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
HOLD HARMLESS
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 nor limit in any way the City's ability to enforce any ordinance provision.
Sound/Noise originating 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 7:OOam to 6:OOpm on
SOUND OR NOISE
weekdays and 10:OOam to 6:OOpm on Saturdays, excluding Sundays and Federal Holidays. At all other
times the noise originating from construction sites/activities must comply with the noise limits of
Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
UNDERGROUND UTILITY
Call for locates of underground utilities prior to any excavation.
LOCATES
!IMOL
INSPECTION TYPE DATE RESULT NOTES
lip
COMPLETE
X-2 ENGINEERING FINAL**
E-7 RESTOR LIMITS
Printed: Friday, October 09, 2020 1:06:16 PM 2 of 2
0 \:L L?,11(7.
"VC. I S'� J
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 109129356 CONTACT:
Susan Sidick
CONTRACTOR: PSE/infrasource Phone #: 425-457-6353
Mailing Address1660 Park Lane Burlington Wa 98233Fax #:
State License #: INFRASL871C2
City Business License #:
Email #: susan.sidick@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 20927 81st PL W
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?
ANY ASSOCIATED PERMITS?
❑ Yes ❑ No
BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : TO REPLACE GAS SERVICE AT APPROX
565' N c/1 of 212th ST SW & 15' W to 12' E c/1 of 81st PL W (1) 3x6 & (1) 3x5 paving cut
anticipated
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year:
PAVEMENT CUT: ❑x Yes ❑ No If yes, indicate size of cut: 3 x 6
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
RIGHT-OF-WAY
CLOSURE
AREA
TOTAL
DURATION
(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 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 6X DQ6IQFN
Contractor or Agent
DATE
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Puget Sound Energy
Traffic Control Supervisor:
Gregory Harwood
Card No. 012238
Card Exp. 09/30/2023
gregory.harwood@pse.com
(425)424-6425
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
TEMPORARY TRAFFIC CONTROL PLAN
#20921
„No�Mp1 •
receiving
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CIO
(AI #20927
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18 118
b , 4 Ln
HOULDER
WOCN
RK
r ti
UTILIT '
WORK j
AHEAD
212TH ST SW
PUGET
SOUND
ENERGY
JOB# 109129356
20927 81ST PL W, EDMONDS, WA
2/6/2020
bob.danskin@pse.com
425-398-6168
SHEET 1 of 2
Applicant shall repair/replace all
damage to utilities or frontage
improvements in City right-of-way
per city standards that is caused or
occurs during the permitted project.
OWNER/CONTRACTOR IS RESPONSIBLE FOR
EROSION CONTROL AND DRAINAGE
ENGINEERING DIVISION
APPROVED AS NOTED
- P � 10/09/2020
Notes:
1. All signs and spacing to conform to the MUTCD
and City of Edmonds standards.
2. All sidewalks, driveways, exits and egresses
shall be completely clear unless otherwise indicated.
3. Channelizing devices are 28" traffic cones.
Use traffic drums (barrels) with steady burning
Type C lights on all State Routes and Hwys.
4. Sign size can be a minimum of 36" x 36" and shall
not obstruct pedestrian access.
5. Crew is required to leave a minimum of 11' for
traveling lane width.
6. Alert affected residents and businesses.
7. Work to take place between 9 a.m. and 4 p.m
unless otherwise specified. All work for arterials
and major roadways will be from 9 a.m. to 3 p.m
8. Work area will be 565' NCL 212th St SW & 15' WCL
81st PI W, 565' NCL 212th St SW & 12' ECL 81st PI W.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
LEGEND
®
28" TRAFFIC CONE
®
WORK PIT
TRAFFIC FLOW
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
ROW
Puget Sound Energy
Traffic Control Supervisor:
Gregory Harwood
Card No. 012238
Card Exp. 09/30/2023
gregory.harwood@pse.com
(425)424-6425
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
TEMPORARY TRAFFIC CONTROL PLAN
#20921
• PARKING
oM 0 To 0
RTOWAWAY AREA
•
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,
#20927
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118
HOULDER
WORK
I ti
UTILIT '
WORK N
AHEAD
212TH ST SW
PUGET
SOUND
ENERGY
JOB# 109129356
20927 81ST PL W, EDMONDS, WA
2/6/2020
bob.danskin@pse.com
425-398-6168
SHEET 2 of 2
Notes:
1. All signs and spacing to conform to the MUTCD
and City of Edmonds standards.
2. All sidewalks, driveways, exits and egresses
shall be completely clear unless otherwise indicated.
3. Channelizing devices are 28" traffic cones.
Use traffic drums (barrels) with steady burning
Type C lights on all State Routes and Hwys.
4. Sign size can be a minimum of 36" x 36" and shall
not obstruct pedestrian access.
5. Crew is required to leave a minimum of 11' for
traveling lane width.
6. Alert affected residents and businesses.
7. Work to take place between 9 a.m. and 4 p.m
unless otherwise specified. All work for arterials
and major roadways will be from 9 a.m. to 3 p.m
8. Work area will be 565' NCL 212th St SW & 15' WCL
81st PI W, 565' NCL 212th St SW & 12' ECL 81st PI W.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
LEGEND
®
28" TRAFFIC CONE
®
WORK PIT
TRAFFIC FLOW
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
ROW
PRE -INSPECTION REPORT
Job #: 109129356
Date: 07/31 /20
Jurisdiction: Edmonds
Right of Way Permit? Q YES
Est. Start Date:
Est. Duration:
❑ NO
Address: 20927 81 st PL W
City / Zip: Edmonds
Customer:
Cust. Email:
PM / Insp: Tanya Martinson
4011l,$If JC,1Fi''!w!XM FA FR",
RECEIVED 10/2/20
CU PHONE NUMBER
PMIINSP PHONE NUMBER
WORK DESCRIPTION: Construction Method
New Construct
Replace 3 4" service and twin with new 1 1 8" PE Existing
p / / Open Trench
Trenchless
PLAT # : 165 068 NOT TO SCALE
N
o T QU pIL W
Fill-
� I
20921
I
I �
I
20927
°° Q Jl�ln Op �] 5° [L CIL
I
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R LI RULfl.l OU Qw
Work Location Size of Cut Surface Type
565, N of CL 212TH ST SW & 1 S W of CL 81 ST PI-W— 3X6 ASPHALT
N S of CL 212TH ST SW & 12, E of CL 81 ST PI-W— 3X5 ASPHALT
N S of CL_ & E W of CL
❑ FLAGGERS #: 1 25 MPH ❑ TROLLEY LINES ❑ BUS STOP #: ❑ METER HOODS #:
❑ OFFICERS #: SPEED LIMIT ❑ TRAFFIC ❑ ARTERIAL ❑ NO PARKS #:
Service I n f o r m a t i o n Pipe Size EFV'S Meters Qtv. Pressure Misc Meter Stuff
❑ COMMERCIAL ❑POTHOLE ❑ 1/2 ❑ 775
[—]STUB ❑ 5/8" ❑ 250
Q RESIDENTIAL ❑MAIN MAINT. ❑ 3/4"❑ 1800 ❑ 6"wc ❑Tempi Bar Size:
❑ EXTENSION ❑ 425
❑ MULTI -FAMILY ❑SERV MAINT. ❑ 11/8 ❑ 2600 ❑ 2# ❑Bollards 2.5" #:
❑ COMPLETE ❑ 11/4" ❑ 630 ❑ > 5#
1-1NEW CONST. ❑ ALTER COMM SVC ❑VALVE MAINT. ❑ 2" ❑ 10,000 ❑ Bollards 4" #:
Fuel Line Permit
❑ CUT 8 CAP ❑ALTER RESID. SVC ❑LEAK REPAIR
❑ 4" ❑ N/A ❑ 1000— ❑ Fuel Line Length:
❑ 6"
❑✓ SERVICE REPL. ❑CP WORK ❑ 8" Mtr LOc: Fuel Line Diameter:
Date
Jurisdiction: Edmonds
Right of Way Permit? [9<S' 0 NO
Est. Start Date:
Est. Duration:
Address: 2092781otP1VV
City /Zip:
Customer:
Edmonds
40 MfSOUND ENON6
PIVI/|nsp Tanya Martinson CUST PHONE NUMBER
PHONE NUMBER
WORK DESCRIPTION:
5 -T-
Construction Method
Trenchless El
PLAT MAP:
7-1
to Ct
Work Location
Size of Cut
Surface Type
EaIFLAGGERS #
MPH
F1 TROLLY LINES
BUS STOP #
METER HOODS #
F] OFFICERS #
SPEED LIMIT
F-1 TRAFFIC SIGNAL
ARTERIAL
[A -NO_ PARKS #
C , mercial
F] Altered Commercial
R Leak Repair
Service Information-
Template Bar
HeEl
loesildential
E14A�'t,lacemesid,rit','
F1 CP Work
Diameter Mety," EFV
New Constr.
F main maintenance
E] Extension
011/8" E] 425 E] 2600
Stub
FI service maintenance
[:111/4" [:] 630 [_110,000
[_1 FUEL LINE PERMIT NEEDED
Extension
F] valve maintenance
Fj
El 2" El 10
7
Fuel Line Length:
compete sery
Cut & Cap
Mtr Loc: 0 31 C,
Fuel Line Diameter:
/
3/4" STW-U
1959
20918
Z
Z Q'
c�
724' N
3/4"
20921
20924
653'N 3/4' STW-U
3/4" 1959
3/4" STW-U 630'N 20927
1959 61 'N
565'N
20924 3/4" STW-U
e 1959 21006
20930
V) LO
M�
N
3/4" STW-U 4-
1960 V)
21010
N 3/4" STW-U
3/4" STW-U T
1959
No electric grid information available Scale 1:450
S 160068, Q 163069 Z
01-30-2020 0Y Lat\Long=47.8086,-122.3428 O
the M'.bls of Ws InlT.omwtiond M.P.ny I�surpb�eM Rec,plent ogles, to not dlsclo a W,-fldontlal inlo�rtnafion to onY� eterr pars nor en11ry canceminp
unless—IhoAmd h Mtlnp by Puget Sound Energy. iNs map is not to be used for determining the actual location of any PSE laci0lles 1_1 11)."
PUGETSOUND ENERGY