Engineering Permit FormRIGHT OF
WIRELESS PERMIT
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PERMITNUMBER,
City of
Edmonds
Edmonds • 98020
Description: T-MOBILE REPLACE 2 ANTENNAS ADD 2 ANTENNAS ON POLE
ISSUED: 06/08/2021
Address: 9726 EDMONDS WAY EDMONDS WA 98020-5940
EXPIRES: 06/03/2022
Type: RIGHT OF WAY WIRELESS Permit Subtype: MACRO COLLOCATION Parcel Number: 00434500000100
wPermit
NAME TYPE NAME
ADDRESS PHONE
APPLICANT T-MOBILE WEST LLC
EDMONDS WA 98026-9206 (425)383-8047
CONTRACTOR RYKA CONSULTING
5628 AIRPORT WAY SOUTH, SEATTLE WA 98108 (206)523-1941
OWNER BERSCHAUER WALTER & DIANNE
19934 NW HOOD POINT RD, SEABECK WA 98380
FEE
INFORMATION
DESCRIPTION
AMOUNT PAID
CITY TECHNOLOGY FEE CHARGED PER PERMIT
$40.00 $40.00
RIGHT OF WAY STANDARD - WIRELESS PERMIT FEE
$330.00 $330.00
•
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.
THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW
RELEASED BY DATE
Printed: Tuesday, June 08, 2021 1:55:33 PM 1 of 2
RIGHT OFWIRELESS PERMIT
PERMITNUMBER,
City of Edmonds
Ave N, Edmonds98020
CONDITIONS
CONDITION TYPE
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.
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.
INSPECTIONS
INSPECTION TYPE
DATE
RESULT
COMPLETE
E-6 ENGINEERING FINAL
ROW TRAFFIC CTRL
Printed: Tuesday, June 08, 2021 1:55:33 PM 2 of 2