ENG2021-0066 ROW PERMITRIGHT OF WAY EUC PERMIT
PERMIT NUMBER
City of Edmonds
-0066
www.cityofedmonds.gov
Description: PSE-INSTALL GAS SERVICE ISSUED: 03/11/2021
Address: 20018 83RD AVE W EDMONDS WA 98026-6726
EXPIRES: 09/13/2021
it Type: RIGHT OF WAY EUC Permit Subtype: MINOR Parcel Number: 00431200000201
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 SIMON J AND MARNE C EVANS 20020 83RD AVENUE W, EDMONDS WA 98026
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.
:»•>/F9:1H ]1
THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW
03/11 /2021
DATE
Printed: Thursday, March 11, 2021 10:20:50 AM 1 of 2
-KRWOF WAY EUC PERMIT
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.
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"
E-7 RESTOR LIMITS
Printed: Thursday, March 11, 2021 10:20:50 AM 2 of 2
RECEIVED
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-,NC. 1 s`) u
FEB 26 2021
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
ROW PERMIT NO.: ENG 2021-0066
ISSUE DATE: 3/11/2021
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 106374689 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: 20018 83rd AVE 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) :
Install gas service at approx 203' S c/l of 200th ST SW & 14' W c/1 of 83rd AVE W
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 5
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 Susan Sidick
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
LEGEND
®
28" TRAFFIC CONE
®
WORK PIT
TRAFFIC FLOW
TfFLAGGER
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
ROW
200TH ST SW
N
TEMPORARY TRAFFIC CONTROL PLAN
0--OHO'
Otl3Ht
W20-1
N
OtlOJ
3Ntll3r
RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
20018 83rd Ave W
Edmonds
WA 98026
USA
SIGN SPACING
MPH
"X"
60/65
1000,
45/55
500'
35/40
350'
30
200'
25
100'
V
D
b3iM AtlMtl MOl
9
1.4
121
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
PUGET
SOUND
ENERGY
JOB# 106374689
20018 83rd Ave W, Edmonds, WA 98026
2/22/21
KALI-JAMAL.COLLINS@PSE.COM
425-424-6425
SHEET 1 of 1
1,-OZM
TOR RESPONSIBLE FOR LOCATING
FIES. RELOCATION/REVISION TO ANY
REQUIRE A SEPERATE PERMIT.
ONTRACTOR IS RESPONSIBLE FOR
;ION CONTROL AND DRAINAGE
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.
ENGINEERING DIVISION
APPROVED AS NOTED
,l.-Il (,VQ✓.ue''Z 03/11/2021
VV
RECEIVED
FEB 26 2021
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
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 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 20T SCL of 200th St SW &
14' WCL of 83rd Ave W
Job #:
Date:
Jurisdiction:
ROW Permit:
Est. Start Date:
Est. Duration:
106374689
2/8/21
EDMONDS
Yes
3/29/21
f Day (8 Hours)
Puget Sound Energy Gas Pre -Inspect Form
Address:
City / zip:
Customer:
PM / Inspector
20018 83RD AVE W
EDMONDS, 98026
RODDY YATES 206-972-3259
Kiara Crofts 425-213-9205
Job Description / Scope of Work
INSTALL 15' OF 1-1/8" PE SCAT STUB AND 55' OF 1-1/8" PE PLAT EXT. SET A425 MSA O/F/R.
New Construction:
Yes
Construction Method
Scat ROW / Plat Property
PLAT Map: 162.069 0
200TH ST SW
cL w
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MAINTAIN A MINIMUM 3' ;
HORIZONTAL SEPERATION a
BETWEEN THE SIDE � I
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RECEIVED
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0=FIRE HYDRANT
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FEB 26 2021
I I
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STORM DRAIN
I
CITY OF EDMONDS
I
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DEVELOPMENT
SERVICES DEPARTMENT ST
S CL W
Work Location
Size of Cut
Surface Type
203'
South
of CL
200TH ST SW
&
14'
West
I of CL
183RD AVE W
3X5
ASPHALT
of CL
&
of CL
Of CL
&
of CL
Service Information
Street Information
Job Type
Diameter:
1-1/8" PE
Flaggers #:
Arterial:
New Residential Svc
EFV:
1-1/8" - 2600 - 9999144
Police #:
TCP:
Tie -In Fitting
Meter:
A425 I I
Speed Limit:
No Parks #:
Meter Loc:
01 - OFR
Trolley Lines:
Mtr Hoods #:
Del Press:
6" W.C.
Traffic Signal:
Bus Stop:
Q
Bollards:
2.5" # I
ADA Ramps #:
Route #'s:
5`E
8403
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The information on the aHached maps is subject to change without notice. Puget Sound Energy makes no warranty, expressed or impHetl, concerning
the suitability of ihi'mformafion for any pure e. Recipient agree to not disclose this conFldential information io an other person or entity,
unless authorizetl In wrlHng by Puget Sountl Energy. This map Is not to be used for determining the ad-1 location of any PSE facilities;call811)."
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RVICES DEPARTMENT