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ENG2020-0371 ROW PERMITOF WAY MINOR PERMIT PERMIT NUMBER City of Edmonds AveRIGHT 980ENG2020-0371 www.cityofedmonds.gov Description: Replace Existing Driveway ISSUED: 09/27/2021 Address: 7820 193RD PL SW EDMONDS WA 98026-6236 EXPIRES: 03/26/2022 rmit Type: RIGHTOF WAY MINOR Permit Subtype: RESIDENTIAL Parcel Number: 00512400001100 i NAME TYPE NAME ADDRESS PHONE APPLICANT HENRY BYAM 7820 193RD PL SW, EDMONDS WA 98026 (206)650-3303 CONTRACTOR MANNY'S SERVICES 6304 51ST PL NE, MARYSVILLE WA 98270 (360)403-5045 OWNER VANVOLKENBURG KATHLEEN M 7820 193RD PL SW, EDMONDS WA 98026 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. :1•i ]1 THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW 09/27/2021 DATE Printed: Monday, September 27, 2021 12:22:20 PM 1 of 2 OF WAY MINOR PERMIT PERMIT NUMBER City of Edmonds AveRIGHT 980ENG2020-0371 www.cityofedmonds.gov• CONDITIONS CONDITION TYPE NOTES Contractor/Owner shall be responsible for repair/replacement of all damage to utilities and/or DAMAGE TO FRONTAGE frontage improvements in city right of way per city standards that is caused by or occurs during the IMPROVEMENTS permitted project. ESC REQUIRED Maintain erosion & sediment control per city standards. UNDERGROUND UTILITY Call for locates of underground utilities prior to any excavation. LOCATES INSPECTIONS INSPECTION TYPE DATE RESULT NOTES COMPLETE X-2 ENGINEERING FINAL" E-7 DWY APPROACH A-1 ENGINEERING PRECON 9/27/2021 JAPPROVED 71 12:00:00 AM Printed: Monday, September 27, 2021 12:22:20 PM 2 of 2 Of ED&JO 01 RIGHT OF WAY CONSTRUCTION PERMIT APPLICATION Complete and submit this Application in accordance with the Submittal "A'C. 1891) Requirements outlined in Right-of-Wgy permit Handout E6S. 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 Info Project Name / Site Address or if no site aAdress use Property Address at NW corner of project area: Associated Permits: BLD PLN ENG Owner and Entity Name of Company Holding• •• Franchise Ordinance No: Point of Contact Title , ul�Pi Address Vq5-21, La City EdA State Zip Phone Email Q P t �J - - - J Contractor and AuthorizedAgent • • Name of Company Sa , • r • • • ! • • Primary Name Agent Name p r Title Title r Mobile AddressA) P Email City Sta e Vr u Zip 2 � Secondary Name Phone n� f� Title Email Mobile City of Edmonds Business License No: Email State License No: 10 A- g , Contractor verifies it is currently bonded Contractor ve_rifie§ it currently has general liability insurance NOTE: ECDC 18.6o.o2o requires that the Application be signed by a licensed anti b6n_de_d­e6ntractor unless otherwise approved by the city engineer. Type of Development — Check ALL that apply ❑ 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 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.) RIGHT-OF-WAY CLOSURE AREA. TOTAL DURATION (Number of Months) Sidewalk 72 hours + LF x LF SF Alley 72 hours + LF x LF SF 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. •- of 1. The work in the right of way is on or for the following type of facilities: ❑ telecom nications ❑ cable ❑ power o gas ❑ water o sewer ❑ storm Details of Wor1c to be Completed 1. Does the utility own ave 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 conne a lot or commercial development with utilities that serve more than one lot or commercial devel ment? 4. Does the work involve rebuilding or locating an existing aboveground utility system which connects a lot or commercial develo nt to an existing underground common utility system? 5. Does the work involve proposed addition to an aboveground utility stem? If es: Are the additions for the purpose of servin ew commercial development? Are the additions for the purpose of serving a le-familyresidential subdivision? 6. Does your project involve rebuilding or replacing utili uipment which currently serves more than one lot or commercial development? If yes, answer the following questions related to project area, i. the actual area in which the Droiect is proposed: 6a. Does your project involve wires/cables/lines? If yes: 1 How manv are existing? --r How many are to be adde ? 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 additionalpoles to be laced? How many? What is the height of the additionalpoles? 6c. Are any poles to be modified/rebuilt/replaced? If yes: How many? 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: APPLICANT PRINTED NAME: 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 9/14/21, 2:15 PM image0000014pg https://mai1.google.com/mail/u/O/#all?projector=1 1!1 m a 0 0 0 0 0 0 rn m