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Updated ROW App - Change in Contractorof EDA40�V' C. i 3a0 SECTION A RIGHT OF WAY CONSTRUCTION RECEIVED PERMIT APPLICATION J U L 23 2021 Complete and submit this Application in accordance with the Submittal Requirements outlined in Right -of -Way permit Handout E63. CITY OF EDMONDS f q � X� DEVELOPMENT SERVICES DEPARTMENT If any field is not applicable to your project, write "N/A" instead of leaving blank-. All fields required. Incomplete Applications will be denied. General , Project Name Adamant Homes 4-Lot Short Plat Site Address or if no site address use Property Address at NW corner of project area: 8717 240th St SW Associated Permits: BLD PLN ENG PLN2019-0052 Owner and Entityllolding•• • Name of Company Adamant Homes, Inc. Franchise Ordinance No: Point of Contact Loree Quade Title Project Manager Address PO Box 14790 city Mill Creek State WA zip 98082 Phone 425-422-9637 Email loree@adamanthomes.com Contractor and Authorized Agent of Owner (see note below) Name of Company Kcon, LLC Contractor Contacts During Construction Primary Name Morgan Kerner Agent Name Morgan Kerner Title President Title President Mobile 425-326-9930 Address 3324 Bickford Ave Email morgan@gokcon.com City Snohomish State WA zip 98290 Secondary Name Phone 425-326-9930 Tide Email morgan@gokcon.com Mobile City of Edmonds Business License No: See attached Email State License No: KCON*CL816B3 Contractor verifies it is currently bonded x Contractor verifies it currently has general liability insurance NOTE: ECDC18.6o.o2o requires that the Application be signed by a licensed and bonded contractor unless otherwise approved by the city engineer. ❑ Multifamily residential ❑ Commercial ❑ City project X Single family residential subdivision ❑ Single family -other ❑ Industrial X Demo and rebuild or from vacant land? ❑ Other, please specify: X Utility Franchise Work associated with development (check one of the above boxes as well) ❑ Traffic Control Only (no associated development) ❑ Utility Franchise Work (no associated development) City of Edmonds ROW construction permit Application --Page 1 of 3 Updated 3/25/2021 Include an overall narrative description of the proposed work. Be specific 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.) Improvements to existing right-of-way and installation of utilities as shown on the civil construction plan set for the proposed 4-lot short plat under city file no. PLN2019-0052. RIGHT-OF-WAY CLOSURE AREA TOTAL DURATION (Number of Months) Sidewalk 72 hours + LF x LF SF Alley 72 hours + LF x LF SF N/A Parking 72 hours + LF x LF SF SECTION B - If you are not a utility company performing work in the City ROW, skip to SECTION C. . The work in the right of way is on or for the following type of facilities: ❑ telecommunications ❑ cable ❑ power ❑ gas ❑ water ❑ sewer ❑ storm Details of Work to be Completed i. Does the utility owner have existing overhead infrastructure in the area of work? Yes No 2. Will any equipment be added underground or above ground (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 existing underground common utility stem? 5. Does the work involve proposed additions to an aboveground utility system? If es: Are the additions for the purpose of serving new commercial development? Are the additions for the purpose of serving a single-family residential subdivision? Detailsof • to be • • Yes No 6. Does your project involve rebuilding or replacing utility equipment which currently serves more than one lot or commercial development? If yes, answer the following questions related to project area, i.e. the actual area in which the project is proposed: 6a. Does your project involve wires/cables/lines? If yes: How many are existing? I I How many are to be added? City of Edmonds ROW construction permit Application --Page 2 of 3 Updated 3/25/2021 6b. I Does your project involve poles? If yes: How many poles are existing in the project area? What is the height of the existing poles? How many poles are to be removed? Are additional poles to be laced? How many? I I What is the height of the additional oles? 6c. Are any poles to be modified/rebuilt/replaced? If yes: How many? I I What is the height of the poles after? Describe the modification rebuild: SECTION C Traffic 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 296-155-305 and must have certification verifying completion of the required training in their possession. Restoration. Restoration shall 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. Insurance. 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 or 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, and 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 perform, in any respect, all authorizations or obligations under the permit. These indemnification requirements shall survive the expiration, revocation, or termination of any resulting permit approval. Acceptance of terms, conditions, and requirements. Applicant accepts the terms, conditions, and requirements set forth in this Application and agrees they apply to any resulting permit and shall comply with them to the satisfaction of the City Engineer. Applicant further agrees to comply with the conditions listed on the Submittal Requirements; with all applicable city ordinances, including but not limited to ECDC Title 18; and with all applicable requirements of state and federal law. Statement of Applicant. I declare under penalty of perjury under the laws of the State of Washington that: I am a licensed and bonded contractor; the information provided herein is correct and complete; and I am authorized by owner to act on its behalf and have authority to bind the owner to this application. Fees. The Applicant is responsible for all permit fees. , APPLICANT SIGNATURE: L APPLICANT PRINTED NAM1 M n erner APPLICANT TITLE: I President NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE TE: City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 ��6 s'caTg of o `� b � 9 w � x s �z 0 �x'L 1889 � Y STATE OF WASHINGTON Limited Liability Company K CON, LLC K CON 3324 BICKFORD AVE SNOHOMISH, WA 98290-9295 BUSINESS LICENSE Issue Date: Jul 02, 2021 Unified Business ID #: 604381256 Business ID #: 001 Location: 0001 Expires: Jan 31, 2022 UNEMPLOYMENT INSURANCE - ACTIVE INDUSTRIAL INSURANCE - ACTIVE TAX REGISTRATION - ACTIVE F CITY ENDORSEMENTS: KIRKLAND GENERAL BUSINESS - NON-RESIDENT #OBL27250 - ACTIVE ISSAQUAH GENERAL BUSINESS - NON-RESIDENT - ACTIVE SAMMAMISH GENERAL BUSINESS - NON-RESIDENT - ACTIVE P SNOHOMISH GENERAL BUSINESS EXPIRES 6/30/2022 -ACTIVE t` EDMONDS GENERAL BUSINESS - NON-RESIDENT (EXPIRES 6/30/2022) -ACTIVE C MERCER ISLAND GENERAL BUSINESS - NON-RESIDENT #190153 - ACTIVE LYNNWOOD GENERAL BUSINESS - NON-RESIDENT #BUS002034-03-2019 - ACTIVE `r� REDMOND GENERAL BUSINESS -NON-RESIDENT #RED17-000441 (EXPIRES 12/31/2021) -ACTIVE F! C LICENSING RESTRICTIONS: Not licensed to hire minors without a Minor Work Permit. REGISTERED TRADE NAMES: K CON This document lists the registrations, endorsements, and licenses authorized for the business named above. By accepting this document, the licensee certifies the information on the application was complete, true, and accurate to the best of his or her knowledge, and that business will be conducted in compliance with all applicable Washington state, county, and city regulations. Director, Department of Revenue UBI: 604381256 001 0001 K CON, LLC K CON 3324 BICKFORD AVE SNOHOMISH, WA 98290-9295 UNEMPLOYMENT INSURANCE - ACTIVE INDUSTRIAL INSURANCE - ACTIVE TAX REGISTRATION - ACTIVE KIRKLAND GENERAL BUSINESS - NON-RESIDENT #OBL27250 - ACTIVE ISSAQUAH GENERAL BUSINESS - NON-RESIDENT - ACTIVE SAMMAMISH GENERAL BUSINESS - NON-RESIDENT - ACTIVE SNOHOMISH GENERAL BUSINESS (EXPIRES 6/30/2022) - ACTIVE EDMONDS GENERAL BUSINESS - NON-RESIDENT (EXPIRES 6/30/2022) - ACTIVE Expires: Jan 31, 2022 RECEIVED JUL 23 2021 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT Director, Department of Revenue ��6 s'caTg of o `� b � 9 w � x s �z 0 �x'L 1889 � Y STATE OF WASHINGTON Limited Liability Company K CON, LLC K CON 3324 BICKFORD AVE SNOHOMISH, WA 98290-9295 BUSINESS LICENSE Issue Date: Jul 02, 2021 Unified Business ID #: 604381256 Business ID #: 001 Location: 0001 Expires: Jan 31, 2022 This document lists the registrations, endorsements, and licenses authorized for the business named above. By accepting this document, the licensee certifies the information on the application was complete, true, and accurate to the best of his or her knowledge, and that business will be conducted in compliance with all applicable Washington state, county, and city regulations. Director, Department of Revenue UBI: 604381256 001 0001 K CON, LLC K CON 3324 BICKFORD AVE SNOHOMISH, WA 98290-9295 UNEMPLOYMENT INSURANCE - ACTIVE INDUSTRIAL INSURANCE - ACTIVE TAX REGISTRATION - ACTIVE KIRKLAND GENERAL BUSINESS - NON-RESIDENT #OBL27250 - ACTIVE ISSAQUAH GENERAL BUSINESS - NON-RESIDENT - ACTIVE SAMMAMISH GENERAL BUSINESS - NON-RESIDENT - ACTIVE SNOHOMISH GENERAL BUSINESS (EXPIRES 6/30/2022) - ACTIVE EDMONDS GENERAL BUSINESS - NON-RESIDENT (EXPIRES 6/30/2022) - ACTIVE Expires: Jan 31, 2022 RECEIVED JUL 23 2021 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT i Director, Department of Revenue