ENG2021-0266 ROW PERMITRIGHT OF WAY EUC PERMIT
PERMIT NUMBER
City of Edmonds
-0266
www.cityofedmonds.gov
Description: PSE-INSTALL TEST LEAD WIRES ON COUPLING, PAVING CUT
ISSUED: 08/11/2021
Address: 719 12TH AVE N EDMONDS WA 98020-2934
EXPIRES: 02/11/2022
rmit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00507000002500
i
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 POWELL TERRY & CALEB 719 12TH AVE N, EDMONDS WA 98020
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 STANDARD - EUC PERMIT FEE
$330.00 $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.
THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW
08/11 /2021
:»•>/F9:1H ]1
DATE
Printed: Wednesday, August 11, 2021 11:23:03 AM 1 of 2
-KRWOF WAY EUC PERMIT
City of • • •
•:• • 1 1 ..
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.
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.
TRAFFIC CONTROL
Traffic Control per approved plan and MUTCD. All Flaggers shall be certified.
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 MEN
RESULT
A-1 JOB START
X-2 ENGINEERING FINAL"
E-7 RESTOR LIMITS
E-7 CONCRETE SIDEWALK
Printed: Wednesday, August 11, 2021 11:23:03 AM 2 of 2
ENG2021-0266
of EpM04O�
RIGHT OF WAY CONSTRUCTION RECEIVED
PERMIT APPLICATION
Jul 19 2021
Complete and submit this Application in accordance with the Submittal CITY OF EDMONDS
LZa� DEVELOPMENT SERVICES
/1�
Requirements outlined in Right-of-Wgy permit Handout E6�. 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.
SECTION A
General •
Project Name 109138053
Site Address or if no site address use Property Address at NW corner of project area: 719 12 AVE N
Associated Permits: BLD PLN ENG X
Owner and Entity Holding Franchise (if applicable)
Name of Company PSE/Infrasource Franchise Ordinance No:
Point of Contact Susan Sid ick
Title SR Permit Specialist
Address 1660 Park lane
city Burlington
State WA
Zip 98233
Phone 425-457-6353
Email susan.sidickapse.com
Contractor and Authorized Agent of Owner
Name of Company
(see note below)
Contractor Contacts During Construction
Primary Name PSE/Infrasource Susan Sidick
Agent Name PSE/Infrasource
Title SR Permit Specialist
Title SR Permit Specialist
Mobile 425-457-6353
Address 1660 Park lane
Email susan.sidick@pse.com
City Burlington
State WA
Zip 98233
Secondary Name
Phone 425-457-6353
Title SR Permit Specialist
Email susan.sidick@pse.com
Mobile
City of Edmonds Business License No:
Email
State License No: INFRASL871 C2
[N Contractor verifies it is currently bonded
d( Contractor verifies it currently has general liability insurance
NOTE: ECDC 18.6o. 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
❑ Single family residential subdivision ❑ Single family -other ❑ Industrial
❑ Demo and rebuild or from vacant land?
ExOther, please specify: test lead wires
❑ Utility Franchise Work associated with development (check one of the above boxes as welt
❑ 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.)
Dig up insulated coupling on 2" stw main. Install two test lead wires on each side of coupling. Cut out any
existing underground wire bond if found. Work area is approx 496' S c/I of Vista Way & N 20' W c/I of
12th AVE W (1) 4x6 payinq cut anticipated
RIGHT-OF-WAY
CLOSURE
AREA
TOTAL
DURATION
(Number of Months)
Sidewalk 72 hours +
LF
I x
LF
SF
Alley 72 hours +
LF
Ix
I LF
SF
Parking 72 hours +
I LF
Ix
I LF
I SF
1 1 day
SECTION B - If you are not a utility company performing work in the City ROW, skip to SECTION C.
1. The work in the right of way is on or for the following type of facilities:
❑ telecommunications ❑ cable ❑ power ix gas
❑ water ❑ sewer ❑ storm
Details of Work to be Completed
1. Does the utility owner have existing overhead infrastructure in the area of work?
Yes
No
x
2. Will any equipment be added underground or above ground (e.. pedestals, vaults, etc.)?
x
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?
x
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?
x
5.
Does the work involve proposed additions to an aboveground utility stem? If es:
x
Are the additions for the purpose of serving new commercial development?
x
Are the additions for the purpose of serving a single-family residential subdivision?
x
Details
of Work to be Completed
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:
x
6a.
Does your project involve wires/cables/lines? If yes:
x
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.
Does your project involve poles? If yes:
X
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 additionalpoles?
6c.
Are any poles to be modified/rebuilt/replaced? If yes:
X
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: Susan Sidick DATE: 07/16/2021
APPLICANT PRINTED NAME: Susan Sidick
APPLICANT TITLE: Sr Permit Specialist
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021
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719 12th Ave N
Edmonds
WA 98020
USA
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 for 719 12TH AVE N will be at 496'
South of centerline of VISTA WAY, and 20' West
of centerline of 12TH AVE W.
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TEMPORARY TRAFFIC CONTROL PLAN
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TOW AWAY AREA
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
^%I/ W41,,,.. z 08/09/2021
VV
OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING
ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY
UTILITIES MAY REQUIRE A SEPERATE PERMIT-
OWNER/CONTRACTOR IS RESPONSIBLE FOR
EROSION CONTROL AND DRAINAGE
SIGN SPACING
MPH
"X"
60/65
1000,
45/55
500'
35/40
350'
30
200'
25
100'
RECEIVED
Jul 19 2021
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
LEGEND
®
28" TRAFFIC CONE
®
WORK PIT
TRAFFIC FLOW
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
ROW -
Puget Sound Energy REV
PUGET Designer: Traffic Control Supervisor:
Gregory Harwood 07/14/2021 0
SOUND MATLOCK HIGHBARGER Card No.012238
ENERGY 808-375-4152 Card ry.hamood@ps Job #
gr�gory.hamood@pse.com
ha rwood@pse. com
MATLOCK.HIGHBARGER@PSE.COM (425)424-6' 109138053
Project Address:
719 12TH AVE N, EDMONDS, WA Page 1 OF 1
0 Job #: 109138053 PRE -INSPECTION REPORT
Proj Rcvd Date: 06/29/21
Jurisdiction: Edmonds
Right of Way Permit? M YES ❑ NO
First Poss Start: 150
First Poss Comp:
15D
Address: 719 12th Ave N
City / Zip: Edmonds 98020
Cust Name:
Customer Email:
PM / Insp: Tanya Martinson 425-417-0639
Job Description / Scope of Work:
lCathodic Protection
I Est. Job Duration: 8 hrs
NEW CONST.
❑ YES 7 NO
dig up insulated coupling on 2" stw
main
and install two
test lead wires
on each side of coupling. Cut out any
IFS / PSE Dig
existing underground wire bond if found. Call John Rockford
before job start. (206)255-2704
Service Work — No Stub Ftg:
Ext Ftg:
Tot Svc Ftg: 0'
Main Ext Work — No
PLAT MAP# 162 067 FIELD INSPECT--M.I.W.ON:
06/30/21
BY: Dave Nichols
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Work
Location
Size of Cut
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496' S of CL Vista Way & 20' W of CL
12th Ave W
4 x 6
concrete
of CL
&
of CL
of CL
&
of CL
❑� FLAGGERS M 2 25
MPH
❑ TROLLEY LINES ❑ BUS STOP M
❑ METER HOODS #:
❑ OFFICERS M SPEED LIMIT
❑ TRAFFIC
❑ ARTERIAL
❑ NO PARKS M
WORK TYPES
Pip e S i z e
EFV'S
Meters gtv.. Pressure
Misc Meter Stuff
❑ COMMERCIAL ❑ STUB
❑ POTHOLE
❑ 1/2"
❑ 5/8"
❑ 775
El250 El6"wC
El Temp I Bar Size:
P
❑ EXTENSION
❑ RESIDENTIAL
❑ MAIN MAINT.
❑ 3/4"
El 1800
-
El COMPLETE
COMPLETE
❑ SERV MAINT.
11/8"
❑ 2600
El425 - ❑ 2#
❑ Bollards 2.5" #:
ElMULTI-FAMILYEl TWIN
El VALVE MAINT.
❑ 11/4"
❑ 2"
❑ 10,000
El630 ❑ 5#
❑ Bollards 4" #:
❑ ALTER COMM SVC
❑ NEW CONST.
❑ 4.1
❑ N/A
-
Fuel Line Permit
❑
El ALTER RESID. SVC ❑ LEAK REPAIR
El6„
❑ 1000
Fuel Line Length:
❑ CUT & CAP ❑ SERVICE REPL.
❑✓ CP WORK
❑ 8"
Mtr Loc:
I Fuel Line Diameter:
801
3/4" STW-U
1963
719 1 /2" STW-U
1967
O
5/8'' PE O
1989
631
421 'S
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408'S
427'
No electric grid information available
S 160062, Q 162067
06-29-2021
The information on the attachetl maps is subject to change without notice. Puget Sound Energy makes no warranty. expressed or implied concerning
the suitability, of this information for any purpose. Recipient agrees to not disclose this confide gial information to any o}her person or entity.
unless authorized in writing by Puget Sound Energy. This map is not to be used for tletermining the actual location of any PSE facilities (call 811)."
5/8'' PE
1991
5/8" PE
1991
1 /2" STW-U
1973
626
Scale 1:450
Lat\Long=47.816,-122.358
OD
- Z
,q-o
M 00
,3
1 1 /8'' MPE
2017-E
5/8" PE
1989
9220
RECEIVED
Jul 19 2021
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
PUGET SOUND ENERGY