ROW APPLICATIONO1F EVA,10
ROW PERMIT NO.: ENG 2021-0037
ISSUE DATE: 2/1 /2021
RIGHT-OF-WAY CONSTRUCTION
INC. ! sic, PERMIT APPLICATION
PROJECT NAME: Circular Driveway CONTACT: Jhony Rodriguez
CONTRACTOR: Jireh Asphalt & Concrete Inc
Mailing Address: 10121 Evergreen Way Suite 25-515
Everett WA 98204
State License #: JIREHCS861 N5
City Business License #:
Phone #: 425 737 6355
Fax #:
Email#: info@jirehconstructioninc.com
0 Liability Insurance 0 Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 16216 N. Meadowdale Road Edmonds WA 98026
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family 0 Single Family ❑ Other
EUC (PUD, VERIZ'ON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes ❑ No
ANY ASSOCIATED PERMITS`? BLD# 2020-0479 ENC# ENG2021-0037
: 24" retaining wail and stairs. Circular Driveway.
DESCRIPTION OF PROPOSED WORK (Be Specific)
! cZy�► S
A
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES ❑ NO ❑ Year:
PAVEMENT CUT:
❑ Yes
No
If yes, indicate size of cut: x
CONCRETE CUT:
Yes
❑ No
If yes, indicate size of cut: Z� x
RIGHT-OF-WAY
AREA
CLOSURE
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + IV LF! X
Alley 72 Hrs + LF X
LF
l Q� SF
LF
SF
Parking 72 Hrs + LIT I
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 hefshe 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 __44-�-DATE �A �-
ontractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE