ENG2021-0032 ROW PERMITOF WAY EUC PERMIT
PERMIT NUMBER
City of Edmonds
AveRIGHT
••01 11
www.cityofedmonds.gov
Description: PSE-INSTALL GAS SERVICE ISSUED: 01/27/2021
Address: 7412 176TH ST SW EDMONDS WA 98026
EXPIRES: 07/27/2021
it Type: RIGHT OF WAY EUC Permit Subtype: MINOR Parcel Number: 00513600001602
I 11-1411 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 BARBARA WEISS-HOLMBERG AND 7416 176TH ST SW, EDMONDS WA 98026
MICHAEL COOK
FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $0.00
RIGHT OF WAY MINOR - EUC PERMIT FEE $110.00 $0.00
REQUIREMENTS
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.
THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW
J. MaJiuga/ 01/27/2021
RELEASED BY DATE
Printed: Wednesday, January 27, 2021 10:22:21 AM 1 of 2
-KRWOF WAY EUC PERMIT
City of • • •
Ave•:• • 1 11
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.
It is the owner's responsibility to repair/replace all damage of utilities or frontage improvements in
DAMAGE TO FRONTAGE
City right of Ways or Easements to City Standards caused by or occurring during the permitted
IMPROVEMENTS
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 REQ
Maintain erosion and sedimentation control per City and SWMMW standard requirements.
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
HOLD HARMLESS
issuance for 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 and 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.
All utilities shall be located prior to any excavation. New locates shall be called for if at time of
UTILITY LOCATES
excavation, original locates are no longer identifiable.
INSPECTIONS
INSPECTION TYPE DATE
RESULT
COMPLETE
A-1 JOB START
X-2 ENGINEERING FINAL"
Printed: Wednesday, January 27, 2021 10:22:21 AM 2 of 2
INC. 1 s`) u
RECEIVED
JAN 26 2021
ROW PERMIT NO.: ENG 2021-0032
CITY OF MONDS
DEVELOPMENT
ISSUE DATE: 1/27/21
SERVICES DEPARTMENT
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: CONTACT: Susan Sidick
CONTRACTOR: PSE/Infrasource Phone #: 425-457-6353
Mailing Address: 1660 Park Lane Burlimzton Wa 9823Yax #:
State License #: INFRASL87I C2
City Business License #:
Email #: susan.sidick@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: W67 6Z
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) :
w1Q&w S1K ( F R WX�G q_ IZ 'U 6 F ORI W 6 7 6 : [
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year:
PAVEMENT CUT: ❑ Yes 0 No If yes, indicate size of cut:
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut:
x
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 Susan Sidick DATE 01/26/2021
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Puget Sound Energy
Traffic Control Supervisor:
Gregory Harwood
Card No. 008997
Card Exp. 08/13/2019
gregory.harwood@pse.com
(425)424-6425 -
176TH ST SVI�
M-O
0
lu
W20-1
W20-7A
W20-4
W3-4
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 State Routes and
4. Sign size can be a minimum of 36" x 36" in9l.a.foid pa};luaaad ay; Bulanp san000
shall not obstruct pedestrian access. ao pasneo sl;ey; spiepue;s A}Io aad
5. Crew is required to leave a minimum of 1 ' f6r?^^;o;y61a A110 ul s}uauaanoadual
a6e1U04 ao sa11111;n o; a5ewep
traveling lane width. Ile aoeldaa/„eda, lleys }ueoilddy
6. Alert affected residents and businesses.
7. Work to take play@`��li��i�fn�.IOISO�IE
unless other\MWs�dR O,� i 1NOO/2�ENM0
and major roadways will be from 9 a.m. to 3 p.m.
8. Work area will be 36' ECL Soundview Dr, & 12' SCL
176th St SW.
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WORK N
AHEAD
&PUGET
ENERGY
SOUND
JOB# 106346227
7412 176th St, Edmonds, WA
September 10, 2018
binyam.yallew@pse
(425) 424-7809
SHEET 1 of 1
1NAIA1b1VdAG SAOIAJ
1N31Nd0-3n34
SONOIAGE d01.110
CHANNEL g"C
DEVICE 113
MPH
TAPER
TANGENT
55/70
40
80
30
60
L3
15/-30
20
40
JAN 26 2021
®
28" TRAFFIC CONE
®
BORE PIT
TRAFFIC FLOW
FLAGGER
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
ROW ROW
Job #:
Date:
Jurisdiction:
ROW Permit:
Est. Start Date:
Est. Duration:
106346227
12/17/20
Edmonds
Yes
4/5/21
1 Day (8 Hours)
Puget Sound Energy Gas Pre -Inspect Form
Address:
City / Zip:
Customer:
PM / Inspector:
RECEIVED
JAN 26 2021
CITY OF EDMONDS
DEVELOPMENT
7412 176TH ST SW SERVICES DEPARTMENT
EDMONDS, 98026
MIKE COOK 425-750-7408
Kevin Williams 425-623-5302
Job Description / Scope of Work
From 2" STW IP 12'S (2267-1960) Run New Scat 1 1/8 PE Service to SFH (14' scat stub 56 scat
New Construction:
ext) and Set 630 Meter Or (Garage Side) 50' ROW
Construction Method
All Scat / Trenchless
PLAT Map:
159070 �
,
MIT ` -
t
1 10
Storm Wrter — —
— — — — — — .pe&d end
-------_
176thStSW sewer
_���� _ ,_—_—_-__
—_==_
Grass/Dirt Steep Hill
04
2" STw IP 1,2'S
W
U 2267-1960
z
1-1/8" PE
CP
0 -0
�w
5/8' MPE
1997
0
MAINTAIN MINIMUM
w 7416 7412
3' HORIZONTAL
SEPARATION
63o
BETWEEN WET (E.G.
j
WATER, SEWER,
STORM) AND GAS
SERVICE.
O
G
I
7Z 160
4
I
189S
L
z
198 �
Q
I
/413 I 7411
426
10
a rn
i
5/6 PE
t
I 1994
Work
Location
Size of Cut
Surface Type
345'
E
of CL
SoundView Dr
&
12'
S
of CL
176th St SW
3x5
GRASS
of CL
&
of CL
of CL
&
of CL
Service Information
Street Information
Job Type
Diameter:
1-1/8" PE
Flaggers #:
No
Arterial:
New Residential Svc
EFV:
1-1/8" - 2600 - 9999144
Police #:
TCP:
Yes
Tie -In Fitting
Meter:
A630
I
I I
Speed Limit:
__
No Parks #:
Steel
- 1" Sery x 1/8" PE Outlet
(MOP) - 125 (3/4" Cutter)
Meter Loc:
07 - OR (rear)
Trolley Lines:
Mtr Hoods #:
Del Press:
6" W.C.
Traffic Signal:
Bus Stop:
Bollards:
2.5" #
4" #
ADA Ramps #:
Route #'s:
i
�1�f7! •+ � "�j (R• '��+ � n Y: 4',.. 'moo - ��-�
\ o
-RECEIVED
JAN 26 2021
` A4.ip
. - CITY OF EDMONDS -
Ir , f' • �•�� DEVELOPMENT
�JJ �.+.;^1 ; Aa•i ;y• SNVICrzS DEPARTMENT
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