ENG2021-0397 ROW PERMITOF WAY EUC PERMIT
PERMIT NUMBER
City of Edmonds
EdmondsRIGHT
98020 1 1 '171
www.cityofedmonds.gov
Description: PSE-RUN COMPLETE ALTERED RESIDENTIAL SERVICE FROM MAIN
ISSUED: 10/26/2021
Address: 21705 96TH AVE W EDMONDS WA 98020-3953
EXPIRES: 04/26/2022
Permit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00373600700802
Isle]'
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 ROGOJAN MAGDELENA & MIREL 21705 96TH AVE W, 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
10/26/2021
VAI!>/F9:1H ]1
DATE
Printed: Tuesday, October 26, 20219:40:26 AM 1 of 2
-KRWOF WAY EUC PERMIT
PERMIT NUMBER
City of • • •
Edmonds•:• • 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 7:00am 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 MEN
RESULT
A-1 JOB START
X-2 ENGINEERING FINAL"
E-7 TRAFFIC CTRL
E-7 RESTOR LIMITS
Printed: Tuesday, October 26, 2021 9:40:26 AM 2 of 2
ENG2021-0397
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SECTION A
RIGHT OF WAY CONSTRUCTION
PERMIT APPLICATION
Complete and submit this Application in accordance with the Submittal
Requirements outlined in Right-of-Wgy permit Handout E6�.
RECEIVED
Oct 07 2021
CITY OF EDMONDS
DEVELOPMENT 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.
General •
Project Name 10 9 b
Site Address or if no site address use Property Address at NW corner of project area: 21705 96TH AVE W
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 ix 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
❑ 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.)
From 1-1/4 pe main run complete altered residential work area is approx 15' W to 12' E c/1 of
96th AVE W & 109' S c/1 of 217th ST SW (2) 3x5 paving cuts 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 +
LF
Ix
I LF
SF
1-2 days
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 ❑ 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
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: 10/07/2021
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
SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM
Puget Sound Energy Gas Pre -Inspect Form
Job #: 109138945
Date: 2/11/20 Address: 21705 96TH AVE W
Jurisdiction: Edmonds City / Zip: EDMONDS, 98020
ROW Permit: Yes Customer: MIREL ROGOJAN 206-992-6916
Est. Start Date: 12/13/21 PM / Inspector: Kevin Williams 425-691-7573
Est. Duration: 1 Day (8 Hours)
RECEIVED
Oct 07 2021
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
Job Description / Scope of Work
From 1-1/4 pe main run complete altered residential service (45' scat stub with 58' plat ext) Set 425
New Construction:
o
meter OR @ Inches
Construction Method
Scat ROW / Plat Property
PLAT Map:
24 S ti
164.062 217th ST SW
I I U6.S.SJ31�-
1
176'E, I TS
lI
21701�
5u,),
II
I
84 S I i --
5/8" MPEI 3/4"
I I
=_—_— I —I-- — — — —
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— — — — — — 2005 196
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107'�] °�-___�_
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425
,r- 9502
--' -I r-
--
- -----------
Itst-'
r 1-118" PE
Utility patches shall be combined and full width or half
I'
0
U I
21705 width overlay will be required depending on the extent
of disturbance. Where utility patches fall entirely withii
c� I
one travel lane, the overlay shall extend to the
centerline of roadway. Where utility patches extend in
15 'S I I ,
I
both travel lanes then a full width overlay is required.
--�--
�-
61'S�i
21709
;
r)l I
L
OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING
�I I O
ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY
gI + � o�
I,
UTILITIES MAY REQUIRE A SEPERATE PERMIT.
0_I I C�'
OWNER/CONTRACTOR IS RESPONSIBLE FOR
�I
Q
EROSION CONTROL AND DRAINAGE
I
I N
�I 4
Applicant shall repair/replace all ENGINEERING DIVISION
21715 damage to utilities or frontage APPROVED AS NOTED
�+
ROW 60'
improvements in City right-of-way
I
per city standards that is caused or ��� ' I,0
occurs during the permitted project. W ✓..ti'u.nnQ 10/26/2021
Work
Location
Size of Cut
Surface Type
15'
W
of CL
96th AVE W
&
109,
F
of CL
217th ST SW
3X5
Asphalt
12'
E
of CL
96th AVE W
&
109,
of CL
217th ST SW
3x5
Asphalt
of CL
&
of CL
Service Information
Street Information
Job Type
Diameter:
1-1/8" PE
Flaggers #:
Yes
Arterial:
No
Altered Residential Svc
EFV:
1-1/8" - 2600 - 9999144
Police #:
No
TCP:
Yes
Tie -In Fitting
Meter:
A425
Speed Limit:
25
No Parks #:
TBD
MDPE - 1 - 1/4" IPS - (DIA) 1"CTS
Meter Loc:
03 - OL
Trolley Lines:
No
Mtr Hoods #:
No
Del Press:
6" W.C.
I Traffic Signal:
No
I Bus Stop:
No
®
Bollards:
2.5" #
1 4" #
I
I ADARamps#:1
No
I Route #'s:
No
TEMPORARY TRAFFIC CONTROL PLAN
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PLACE SIGNS ALONG
WORK AREA
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 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 will be 15' WCL of 96th Ave W and
109' WCL of 217th St SW. Then 12' ECL of 96th
Ave W and 109' WCL of 217th St SW.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
UJI
Q
CID
RECEIVED
Oct 07 2021
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
ENGINEERING DIVISION
APPROVED AS NOTED
.le" 10/26/2021
217TH ST W
1 I
•
•
• I
• I•
• RECEIVING PIT
1
t •
f 21705
�I
,I RESIDENT(S) WILL BE INFORMED
' OF POSSIBLE TEMPORARY
IDRIVEWAY CLOSURE
I
I o Q
I • � o
o `lr^ �
' ONE LANE p
ROAD C\1
4 CD AHEAD
12!11
WORK
SIGN SPACING
MPH
"xn
60/65
1000,
45/55
500'
35/40
350'
30
200'
25
100'
CD
C\J
E.
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
FLAGGER
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
ROW
Puget Sound Energy REV
Designer: Traffic Control Supervisor:
PUGET John Crofoo[ 10/04/2021 0
SOUND John Crofoot Card No. 012613
124
ENERGY 425-424-6658 John Cro. "@'pse.com Job #
John.Crofoot@PSE.com (425)424-6658 109138945
Project Address: J4' V.C" . ll
21705 96TH AVE W, EDMONDS, WA 98020. 1 Page 1 OF 2
TEMPORARY TRAFFIC CONTROL PLAN
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PLACE SIGNS ALONG
WORK AREA
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 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 will be 15' WCL of 96th Ave W and
109' WCL of 217th St SW. Then 12' ECL of 96th
Ave W and 109' WCL of 217th St SW.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
9�
217TH ST W
RECEIVED
Oct 07 2021
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
CREW SHALL POTHOLE
FOR WATER MAIN DEPTH
PRIOR TO PROJECT START
21705
RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
04
CD
N
ONE LANE '
ROAD 04
AHEAD
ROAD T
WORK o
4HEAD N
SIGN SPACING
MPH
'X'
60/65
1000,
45/55
500'
35/40
350'
30
200'
25
100,
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
FLAGGER
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
NOW
Puget Sound Energy REV
D e s l g n e r. Traffic Control Supervisor:
PUGET John Crofoot c;dNo.cr 012613 10/04/2021 0
SOUND
ENERGY 425-424-6658 JohnCrofoa@pse.corn Job #
John.Crofoot@PSE.com (425)424-6658 109138945
Project Address:
21705 96TH AVE W, EDMONDS, WA 98020. Page 2 OF 2