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ENG2021-0276 ROW PERMITOF WAY MINOR PERMIT PERMIT NUMBER City of Edmonds EdmondsRIGHT 98020 1 1 www.cityofedmonds.gov Description: PAINE-REMOVAL OF 2 TREES IN ROW ISSUED: 08/12/2021 Address: 9523 190TH PL SW EDMONDS WA 98020 EXPIRES: 02/12/2022 rmit Type: RIGHTOF WAY MINOR Permit Subtype: RESIDENTIAL Parcel Number: 00434600007801 i NAME TYPE NAME ADDRESS PHONE APPLICANT SUSAN PAINE 9523 190th St SW Edmonds, WA 98026 (206)371-5148 CONTRACTOR Eco Tree NW Inc 6416 176th St SW, Lynnwood WA 98037 (206)337-2422 OWNER Susan Paine 9523 190th St SW, Edmonds WA 98026 (206)371-5148 FEE INFORMATION DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $40.00 ENGINEERING INSPECTION FEE $110.00 $110.00 RIGHT OF WAY MINOR PERMIT FEE $110.00 $110.00 • 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 08/12/2021 :»•>/F9:1H ]1 DATE Printed: Thursday, August 12, 2021 12:06:46 PM 1 of 2 CONDITIONS CONDITION TYPE NOTES 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. ESC REQ Maintain erosion and sedimentation control per City and SWMMW standard requirements. 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 TYPE DATE RESULT NOTES COMPLETE X-2 ENGINEERING FINAL" Printed: Thursday, August 12, 2021 12:06:46 PM 2 of 2 �=- City of Edmonds Map Title . S• . Lynrw�d 1 �J • Moun:l.• � J Legend — • • • - ArcSDE.GIS.STREET CENTERLINE — <all other values> r { • t z — • — + ; 4 9; 71; 7; 8 --' • ', �e - Applicant shall repair/replace all damage to utilities or frontage _ �. �tr' ♦ _ ... improvements in City right-of-way ,I, `i�i � • per city standards that is caused or occurs during the permitted project. t • r • 1 i 4 • • OWNERICONTRACTOR IS RESPONSIBLE FOR EROSION CONTROL AND DRAINAGE 1 • •` RESPONSIBLE LOCATING OW ON SITEUTILITIES. ALL ONSITEUTILITIRE REQUIRE A STIONIREVISIONIT ANY UTILITIES MAY REQUIRE A SEPERATE PERMIT. • • ` III • r _ • � ��---fir �� _ _— _ i �• r��� r _ +• ENGINEERING DIVISION APPROVED, 07/29/2021 I Trees to be removed. 1: 189 Notes 0 15.79 31.6 Feet 282 23.5 This map is a user generated static output from an Internet mapping site and is for WGS-1984_Web-Mercator-Auxiliary-Sphere reference only. Data layers that appear on this map may or may not be accurate, current, or otherwise reliable. © City of Edmonds THIS MAP IS NOT TO BE USED FOR DESIGN OR CONSTRUCTION ENG2021-0276 QF EL)IfV RECEIVED RIGHT OF WAY CONSTRUCTION PERMIT APPLICATION J U L 23 2021 Complete and submit this Application in accordance with the Submittal saRequirements outlined in Right -of -Way permit Handout E63. CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT If any field is not applicable to your project, write "N/A" instead of leap irb All fields required. Incomplete Applications will be denied. SECTION A Project Name Site Address or if no site address use Property Address at NW corner of project area: G� j _ i qJ -7 [ vu) Cf�j Associated Permits: I BLD I ENG Name of Company Franchise Ordinance No: Point of Contact Susan Paine, Homeowner Title 9523 190th PI SW Address 206-371-5148 City State Zip Phone Email Name of Company L6 �� Primary Name Agent Name Title Title Mobile Address ZZ 50'1 Email City +, State �� Zip �/02- I Secondary Name Phone �fy _ z + —`(? 2 Title Email 0 1 U C CU E y e P_VA U-) 0, 1 VlLen C 0-y" Mobile City of Edmonds Business License No: ` Email State License No: U too,( - Z 3 3 ' If to Contractor verifies it is currently bonded Contractor verifies it currently has general liability insurance AWE: ECDC x8.6a.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? KOther, please specify: T (-,- z ,-' M rti°"-�- 0-0 w ( rw CO n f5` c q v-vx� ❑ 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 i 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.) A-� i Per tkx0 IN RIGHT-OF-WAY CLOSURE AREA TOTAL DURATION (Number of Months) Sidewalk 72 hours + LF x LF SF k( 4 Alley 2 hours + LF x LF SF 1 FV Parkin 2 hours + LF x LF SF I IJ <r SECTION B -If you are not a utility company performing work in the City ROW, sip to SECTION C. 1. The work in the right of way is on or for the following type of facilities: ❑ telecommunications ❑ cable ❑ power ❑ gas ❑ water ❑ sewer ❑ storm Does the utilityowner have existingoverhead infrastructure in the area of work? 2. Will an equipment be added underground or above round (e. pedestals,vaults etc.)? 73.i. If es, describe: 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 stem? 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? 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? 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: 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 les to be laced? How many? I What is the height of the additionalpoles? 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: DATE: APPLICANT PRINTED NAME: ( v APPLICANT TITLE: NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 •., NW Office Use only: Wwilec • "�� �' 64:16176th -ST. SW Lynnwood,: WA 98037 ' rr '7 ..;. 206-337-2422 fax 1-888-623-0091 Email : oifice@ecotreenw.com _c6 NAME:� i Inc,PHOI�TE:(a-ZI ' SI DATE:. ADDRESS • I `L % I _�1.C2�'-�! p) it (�/ CITY: �d r��, rA 5 ZIP ZP� . n� EMAIL ADDRE,1 NOTESS SOURCE. k I. I ,1.1: . u r® I`% a, t7 r. SERVICES BID ALL TREE ]REMOVAL PRICES, INCLUDE HAULING BRUSH; LEAVING WOOD iN 18" ROUNDS, CUTTING STUMP LOW AS TEASIILE, AND CLEAN UP UNLESS OTHERWISE NOTEDRELOW. _ f r• ; S'UB S 6Z5'©p; _ DEVELOPMI=NT TAX S. TOTAL $ n v 00 If stump:grinding is bid, ki debris are to b'e left and are the customer's responsibility. Full payineni due upon completion of job. We reserve the right to eaneel this agreement at any time. Uotreell* Inc will not:be liable for. damages to•undergrognd Villitica and/or sprinkler systems if the customer does not indicate, on this•form, their existence to the work area: The customer 1$ responsible for obtaining,any permits r'ecjuired Ly. the government. F.cotrcenry Inc is Rot responsible for. arry violation and/or penalty If permits are required and not obtelined by the customerAtis the customer's responsibility to know the boundaries of their land and to have the author- ity to have the work performed. Acceptance of proposal —The above prices, specifications and conditions are satisfactory and hereby accepted..You are authorized to do the work as specified. Payment will be furnished as specified above. /2) / I . Signature: � — Date: ZoZ Licensed, Boinded and Insured for -Two Million Dollairs. Contractors Licepse#ECOTRI 8Z.2KA• ,CirGradt�lina nnrnc. ACORl� CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) 12/30/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: P"°NE (425) 348-7520 a/c No): (425) 348-2575 Stark Solutions, Inc. E-MAIL kurt@starksolutionsinc.com 11700 Mukilteo Spdwy INSURERS AFFORDING COVERAGE NAIC # Ste 201-1061 INSURER A: Nautilus Insurance Co Mukilteo, WA 98275 INSURED INSURER B : INSURER C : ECOTREENW Inc INSURER D : 6416 - 176th St SW INSURER E : Lynnwood WA 98037 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR OF INSURANCE ADDLSUBRTYPE INSp WVp POLICY NUMBER POLICY EFF MM DD/YYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE � OCCUR DAMAGMISE TO RENTED $ MED EXP (Any oneperson) $ NN1211926 01/01/2021 01/01/2022 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER : GENERAL AGGREGATE $2,000,000 POLICY PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $ Incl $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Fa acc dent) $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PR OPERTYidenaAMAGE D $ NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEDT I RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ RECEIVED DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) J U L 23 2021 Verification of insurance CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT CERTIFICATE HOLDER CANCELLATION State of WA/ Dept of L&I Contractor Registration PO Box 44450 Olympia, WA 98504 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ' C <KS> © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD