ENG2021-0369 ROW PERMITRIGHT OF WAY EUC PERMIT
PERMITNUMBER,
City of Edmonds
. •:� i 1 1 ' •
. -. •.
777
Description: PUD-REPLACE ALL POLE MOUNTED ANTENNA EQUIPMENT
ISSUED: 10/07/2021
Address: 21909 96TH AVE W EDMONDS WA 98020-3920
EXPIRES: 04/07/2022
rmit Type: RIGHT OF WAY EUC Permit Subtype: MINOR Parcel Number: 00373600700901
i
NAME TYPE NAME ADDRESS PHONE
APPLICANT SNOHOMISH COUNTY PUD P.O. BOX 1107, EVERETT WA 98206 (425)670-3216
CONTRACTOR SNOHOMISH COUNTY PUD P.O. BOX 1107, EVERETT WA 98206 (425)670-3216
OWNER HECOX WILLIAM J 21909 96TH AVE W, EDMONDS WA 98020-3920
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 MINOR - EUC PERMIT FEE
$110.00 $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
10/07/2021
:»•>/F9:1H ]1
DATE
Printed: Thursday, October 07, 2021 1:05:49 PM 1 of 2
-KRWOF WAY EUC PERMIT
City of • • •
www.cityofedmonds.gov• •
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 7:00am to 6:00pm on
SOUND OR NOISE
weekdays and 10:00am and 6:00pm 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 TYPE
DATE
RESULT
COMPLETE
A-1 JOB START
E-7 TRAFFIC CTRL
X-2 ENGINEERING FINAL"
Printed: Thursday, October 07, 2021 1:05:49 PM 2 of 2
ENG2021-0369 WO# 100083887
��ofEOMoti RECEIVED
�`� RIGHT OF WAY CONSTRUCTION SEP 14 2021
PERMIT APPLICATION
Complete and submit this Application in accordance with the Submittal CITY OF EDMONDS
zDEVELOPMENT
/'Vc. i s`)3 Requirements outlined in Right -of -Way permit Handout E6�. 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.
SECTION A
General •
Project Name T-Mobile Edmonds Parkway Modification 2021
Site Address or if no site address use Property Address at NW corner of project area: 21909 96th Ave W Edmonds, WA
Associated Permits: BLD PLN ENG
Owner and Entity Holding Franchise (if applicable)
Name of Company Snohomish County PUD No.1 Franchise Ordinance No: N/A
Point of Contact Aziz Haq
Title Engineer
Address P.O. Box 1107
City Everett
State WA
zip 98206
Phone 425-783-5251
Email Jointuse@snopud.com
Contractor and Authorized Agent of Owner
Name of Company Same info as above
(see note below)
Contractor Contacts During Construction
Primary Name
Agent Name
Title
Title
Mobile
Address
Email
City
State
zip
Secondary Name
Phone
Title
Email
Mobile
City of Edmonds Business License No:
Email
State License No: 313-005-741
Q Contractor verifies it is currently bonded
® 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?
❑ Other, please specify:
❑ Utility Franchise Work associated with development (check one of the above boxes as welt
ER Traffic Control Only (no associated development)
w 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.)
Work consists of replacing all pole mounted antenna equipment including antennas, radios, mounts and
cabling with new. This work is a modification of the existing cell site. The pole is located on the east side of 96th Ave W.
The north bound lane shall be closed to accommodate equipment and traffic control setup per the included plan.
Requesting work hours of 8AM to 6PM, Monday thru Friday.
No tree trimming required.
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 +
LF
Ix
I LF
SF
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 u power ❑ 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
X
No
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
x
project is proposed:
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? 1
x
What is the height of the existing poles? 93'
How many poles are to be removed? o
X
Are additional poles to be laced?
x
How many? 1 o 1 What is the height of the additionalpoles?
6c.
Are any poles to be modified/rebuilt/replaced? If yes:
x
How many? 1 1 1 What is the height of the poles after? 93'
Describe the modification rebuild: Replacing antenna equipment on pole top for T-Mobile. Pole stays the same.
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:
APPLICANT PRINTED NAME:
APPLICANT TITLE:
AZIZ HAQ
ENGINEER
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
9/13/21
City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021
=MISHCOUNTY
T-MOBILE EDMONDS PARKWAY - SE01575A
CONSTRUCTION OPERATIONS AND ENGINEERING REQUEST
TO FROM DATE
KEITH ELLISON AL I/_ HAQ 425-5iti—+z-U9 9/9//I
ADDRESS/LOCATION/POLE NUMBER
Z iyvy yn i rn Hvt W EDMONDS, WA // 25(27-3)NE // PLI: 247850
MAP NO. ORDER NO. OPERATION NO.
454-H7 100083887 30
ACTION•
PLEASE ASSIST T-MOBILE WITH THE MODIFICATION OF THEIR ANTENNA SITE
MOD INCLUDES REPLACING ALL POLE MOUNTED EQUIPMENT WITH NEW
POLE HEIGHT: 93' AGL (2) HIGHLINE BUCKETS REQUIRED
COORDINATE WITH KEITH ELWELL - 425-754-3458 TRANSMISSION OUTAGE
WINDOW:
SEE T-MOBILE DRAWINGS FOR MORE DETAILS
EQUIPMENT WEIGHTS ON DRAWING A-3
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SL
-130185-A
51 J9TH ST§W510136
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1
1247850
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909 A-45830
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21915
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IS SL-130194-A
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1 1513167 15-13187 2
12-1334
1138 1137 1 83
18
N
313
NORTH
For de -energizing customer service for Customer work cusTOVFP
CREW HOURS
When completed, coil
the PUD at 425-783-1000
or (1-877-783-1000) ask
Customer Signature Date for Energy Control Dispatch
ACTIONOR OTHER ACTIONREQUIRED
ENGINEERING DIVISION RECEIVED
APPROVED AS NOTED Applicant shall repair/replace all
damage to utilities or frontage
improvements in City right-of-way SEP 14 2021
%�� (,UO.�x�,,,,,� 10/06/2021 per city standards that is caused or
VV occurs during the permitted project.
CITY OF EDMONDS
DEVELOPMENT
SCF EDULE ALL INSPECTIONS T TROUGH MYBUILDINGPERMIT.COM DAT�ERVICES DEPARTMENT
Distribution: White -Deportment Responsible For Work -Return To Originator When Completed Blue-GIS, 03, After Work Completion
Conory-Deportment Responsible For Work -File Copy Pink -Originator
LANE CLOSURE ON A TWO-LANE ROAD RECEIVED
(TWO FLAGGER OPERATION)
SEP 14 2021
ROAD
W ! WORK
AHEAD
CITY OF EDMONDS
DEVELOPMENT
ONE LANE > SERVICES DEPARTMENT
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G20-2 ROADNWOR i W20-7A W20-78
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(OPTIONAL) t
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TO STOP
ROAD OPTIONAL IF
ENGINEERING DIVISION s WORK-1 40 MPH OR LESS
APPROVED AS NOTED AHEAD
^Jill 10/06/2021vv SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM
SNOHOMISH COUNTY
TDa D= TRAFFIC CONTROL PLAN
PUBLIC UTILITY DISTRICT NO 1
PROJECT T-MOBILE EDMONDS PARKWAY MODIFICATION 2021
LOCATION 21909 96TH AVE W EDMONDS, WA
ENGINEER DATE 9/9/21 ORDER 100083887
PHONE
CELLULAR