ROW PERMIT APPLICATION PLN2019-0036 SUNDSTONE 2 LOT SPJ4 f VA)UIV`' D
VE RECEI
FIGHT OF WAY CONSTRUCTION MAY RECEIVED
PERMIT APPLICATION
Complete and submit this Application in accordance with the Submittal CITY OF EDMONDS
Requirements outlined in Right -of-Way Ii111t }i�,.`',.,..� p�,,, DEVELOPMENT
WjdV tt y,&3. SERVICES DEPARTMENT
If any field is not applicable to your project, write "N/A" instead of leaving blank
All fields required. Incomplete Applications Hill he denied.
SECTION A
i ItiT.T MKI, . 6",
1112
1
4M
n Multifamily rtmidential c Commercial o City project
r. Single family residential subdivision Single family -ether c, Industrial
. I Demos and rebuild or from vacant land?
a Other, please specify
u Utility Franchise Work associated %%ith development (check one -of the abo w boxes as wyff)
n Traffic Control Only (no associated development)
n Utility Franchise Work (no associated development)
City of Edmonds ROW construction pernit Applic-ati,m—Page 1 of 3 Updated 3/25 2n21
Include an overall narrative description of the proposed work, Be.specift and detailed:
Describe infrastructure to be impacted, such as, poles, wires, conduit,. utility mains, etc.
Include whether this is construction; maintenance, or repair.
Include description of proposed construction. methods, (e.g., Bores, trenches,. overhead wires proposed, depth .for
underground utilities, etc..)
RIGHT-�OF WAX
CLOSURE
AREA
TOTAL
DURATION
(Number of Months)
Sidewalk 2_hours +
IF
x .
_ LF
SF'
Alle , ,2 hours +
LF
is
LF
SF
Parldng,72 Hours +
I. LF
x
LF
SF
SECTION B --If you are: not a utility company performing. wor. k in the City ROW, skip to SECTION C.
i. The work in the aright of way is.on or for the
a telecommunications ❑ cable.
❑ water o sewer:
o power ❑ gas
❑. storm
i.
.
Does the utility owner have existing overhead infrastructure in the area of work?
.
2.
1 Will any equipment be added underground d or above groand e.. pedestals, vaults etc.)?
If yes, describe:
3.
Does the proposed work connect a lot or commercial development with utilities that serve more
than one lot or commercial development?
4.
Does the work involve rebuilding or relocating an :existing:'aboveground utility system which
connects a lot`or commercial development to.an existin underground common utili ' stem7
Does the workinvolve proposed additions to an aboveground utility system? If:yes.-.;'
:Are the: additions for the Purpose of seMng new commercial development?.
Are the additions for the purpose of serving asingle-family residential subdivision?:
Details
of Work to be Completed
Yes
No
6.
Does your project involve rebuilding or replacing utility equipment:whieh currently serves more
than one.lot or:commercial developmennt? .
If yes; answer the following questions-related'.to projectareaj.p. the actual area in which the
project 'is proposed:
6a..
Does your project involve wires/cables/lines? If yes:
Flow man are existing? How many are to be added?
City of Edmonds ROW construction permit Application --Page 2 of g. Updated 3/25/2021.
Gb.
Does your project involve poles? Ifyes:
Haw many Poles are existing in the project area?
What is tlic hei ht of the. existingpoles?
:.r
How man Polesare to be removed?
Are additional voles to be laced?
How man ?
What is the he t of the additional'poles?
be.
Areanypolesto.bemodified/rebuilt/replaced? .Ifyyes;
Haw many.? What is the height of the poles after?
Describe the modification rebuild:
SECTION C
'tratlic Control and Public Safety: 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 2g6sg 3n5 a..d must have:
certification verifyingcompletion of the required training in .their possession.
Restoration. Restoration shall be iri accordance with City codes and Standards. All street cut trench:work>shall. be
etched with as halt or Ci P p ty approved material prior to the end of the workday -NO EXCEPTIONS.
Instrance. The City may require the owner or contractor to provide proof of insurance acceptable to the City prior to
any permit approval,.
Indemnification. The Applicant agrees to defend, indemnify, and hold harmless the City of Edmonds, its officials,
officers, employees; and agents. against any injuries, damages, or claims of any kind or description whatsoever,
foreseen unforeseen, including defense costs and attorney fees, resulting directly or indirectly from:any act or
omission of the:.Applicant; its°subcontractors, anyone directly or indirectly employed by them, a xd anyone for whose:
acts or omissions they may be:;liable, arising out of, related to, or by reason of the granting of this permit; and
specifically including but not limited to all loss by -the failure of the Applicant to fully or adequately perforni, in any
respect, :all authorizations or obligations under the permit. These indemnification requirements shall survive the
expiration, revocation, or -termination of anyiesWtingpermit approval:.
Acceptance of terms, conditions and requirements. Applicant accepts the terms, conditions, and
requirements set forth in thisApplicatiori and agrees they. apply to any resulting permit and shall compIywith them to
the satisfaction'of the City Engineer. Applicant further agrees to complywith the conditions listed on the Submittal
Requirementsy with ail applicable city ordinancest. including but not limited to ECbC Title x8,; and with all applicable
requireTnents of state.and federal law:
PP penalty of perjury under the laws of the State of Washington thaf:.T airi a
Statement o f A licant, I declare under enal
olwner o act on censed s behalf and haved contractor; auharaty to biformation nd
herein is.correct and complete; and I am:autho�rized by
d the owner to this application:
Fees., The Applicant is responsible for.all�erm't fees.
NO WORD SHALL BEGIN PRIOR, To PERMIT ISSUANCE
City of. Edmonds ROW construction permitApplication.-Page 3 of 3 Updated %25/2o2i