ENG2021-0435 ROW PERMITRIGHT OF WAY PERMIT
PERMIT NUMBER
City of Edmonds
...0i 1 1
www.cityofedmonds.gov
Description: SELECT -CIVIL CONSTRUCTION IMPROVEMENTS PER PLN2021-0007
ISSUED: 01/27/2022
Address: 20323 81STAVE W EDMONDS WA 98026-6713
EXPIRES: 01/18/2023
rmit Type: RIGHT OF WAY Permit Subtype: SUBDIVISION Parcel Number: 00431200001501
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NAME TYPE NAME ADDRESS PHONE
APPLICANT SELECT HOMES INC. 8304 212th St SW, EDM0NDS WA 98020 (206)963-3787
CONTRACTOR SELECT HOMES INC 8304 212th ST SW, EDMONDS WA 98026
OWNER SELECT HOMES INC 8304 212th ST SW, EDMONDS WA 98026
FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE CHARGED PER PERMIT
$40.00 $40.00
RIGHT OF WAY STANDARD PERMIT FEE
$330.00 $330.00
REQUIREMENTS
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
01 /27/2022
RELEASED BY
DATE
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RIGHT OF WAY PERMIT
PERMIT NUMBER
City of Edmonds
...0iENG2021-0435
www.cityofedmonds.gov•
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.
Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to
indemnify defend and hold harmless the City of Edmonds, Washington, its officials, employees, and
agents from any and all claims for damages of whatever nature, arising directly or indirectly from the
HOLD HARMLESS
issuance for this permit. Issuance of this permit shall not be deemed to modify, waive or reduce any
requirements of any City ordinance nor limit in any way the City's ability to enforce any ordinance
provision.
INSP PRIOR TO BACKFILL
Call for all required inspections. All work shall be inspected prior to backfill.
Electronic civil asbuilt shall be submitted to the City prior to final project acceptance. Asbuilt shall be
PROJECT CIVIL ASBUILT
submitted to Engineeringpermits@edmondswa.gov.
SEWER 10' SEPARATION
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.
UNDERGROUND WIRING
All new, extended, rebuilt, or relocated electrical utility and/or service shall be placed underground.
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
A-1 ENGINEERING PRECON
A-1 TESC AND MOBILIZE
E-7 CONCRETE SIDEWALK
E-7 CURB GUTTER
E-7 DRY UTILITY LOCATION
E-7 DWY APPROACH
E-7 FH REFLECTOR
E-7 MAILBOX LOCATION
E-7 PUBLIC ROAD
E-7 PVMT SUBGRADE
E-7 RESTOR LIMITS
E-7 SEWER LATERAL
E-7 STRIPING
E-7 TRAFFIC CTRL
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Lti�y of EpiyO�o�
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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 -Way permit Handout E63.
RESUB
Jan 27 2022
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 20323 81 st Ave. W - 2 lot short plat
Site Address or if no site address use Property Address at NW corner of project area: 20323 81 st Ave. W
Associated Permits: BLD PLN PLN2021-0007 I
ENG
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.• .• -
Name of Company
Franchise Ordinance No:
Select Homes, Inc.
Point of Contact
Kayla Nichols
Title
Project Coordinator
Address
8304 212th St. SW
City
Edmonds
State WA
Zip 98020
Phone
425.742.6044
Email
kayla.clark@outlook.com
Contractor and Authorized Agent of •
• - •• •w)
Contractor ContactsDuring
Construction
Name of Company Select Homes, Inc.
Primary Name
Gary Klick
Agent Name Kayla Nichols
Title
Superintendent
Title Project Coordinator
Mobile
206.730.0670
Address 8304 212th St. SW
Email
gary@selecthomeswa.com
City Edmonds
State WA
Zip 98020
Secondary Name
Phone 425.742.6044
Title
Email kayla.clark@outlook.com
Mobile
City of Edmonds Business License No:
Email
State License No: SELECH110KN
IN Contractor verifies it is currently bonded
Contractor verifies it currently has general liability insurance
NOTE: ECDC 18.6o.02o 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 well)
❑ Traffic Control Only (no associated development)
City of Edmonds ROW construction permit Application --Page 1 of 3 Updated 3/25/2021
❑ Utility Franchise Work (no associated development)
Project Description
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.)
Install frontage improvements along 81 st Ave Wand 203rd St SW. The improvements include curb, gutter and sidewalk along 81 st Ave W;
pavement widening and thickened edge along 203rd St SW; two driveway access aprons; power pole relocation near the intersection; and open
cut utilities (stormwater, sanitary sewer, water, power, gas and communications).
RIGHT-OF-WAY
CLOSURE
AREA
TOTAL
DURATION
(Number of Months)
Sidewalk 72 hours +
LF
JxJ
LF
SF
Alley 72 hours +
LF
JxJ
LF
SF
Parking 72 hours +
LF
JxJ
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 ❑ power ❑ gas
❑ water ❑ sewer ❑ storm
1.
CompletedDetails of Work to be
Does the utility owner have existin overhead infrastructure in the area of work?
•
2.
Will any equipment be added underground or above ground (e.g. pedestals, vaults, etc.)?
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?
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 system?
5.
Does the work involve proposed additions to an aboveground utility system? 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?
Details of • to be Completed
®i
6. Does your project involve rebuilding or replacing utility equipment which currently serves more
than one lot or commercial development?
City of Edmonds ROW construction permit Application --Page 2 of 3 Updated 3/25/2021
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? I I How many are to be added?
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 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:
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: /YZ A DATE: 12.22.21
APPLICANT PRINTED NAME: Kayla Nichols
APPLICANT TITLE: Project Coordiantor
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021