ENG2022-0024 ROW PERMITRIGHT OF WAY EUC PERMIT
PERMIT NUMBER
City of Edmonds
-0024
www.cityofedmonds.gov
Description: PSE INSTALL NEW GAS SERVICE CAP OLD WITH CUTS ISSUED: 02/08/2022
Address: 111 12TH AVE N EDMONDS WA 98020-2992
EXPIRES: 08/07/2022
rmit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00423000003800
i
NAME TYPE NAME ADDRESS PHONE
APPLICANT SUSAN SIDICK 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353
CONTACT PUGET SOUND ENERGY- CORROSION 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353
DEPARTMENT
CONTRACTOR PSE/INFRASOURCE 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353
OWNER ZOLOTH SCOTT M & AMY C 111 12TH AVE N, EDMONDS WA 98020
FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE CHARGED PER PERMIT
$40.00 $40.00
ENGINEERING INSPECTION FEE
$220.00 $220.00
RIGHT OF WAY STANDARD - EUC 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
02/08/2022
RELEASED BY
DATE
Printed: Tuesday, February 08, 2022 10:23:11 AM 1 of 2
WAY EUC PERMIT
PERMITNUMBER,
City of Edmonds
Ave-KRWOF
•:• •ENG2022-00121
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.
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.
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"
E-7 CONCRETE SIDEWALK
E-7 CURB GUTTER
E-7 RESTOR LIMITS
Printed: Tuesday, February 08, 2022 10:23:11 AM 2 of 2
of EpM04O� RECEIVED
RIGHT OF WAY CONSTRUCTION
PERMIT APPLICATION JAN 25 2022
Complete and submit this Application in accordance with the Submittal CITY OF EDMONDS
/'Vc. is') Requirements outlined in Right -of -Way permit Handout E6�. 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.
SECTION A
General•
Project Name 109138962
Site Address or if no site address use Property Address at NW corner of project area: 111 12th AVE N
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 d4Single 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.)
Cut and cap gas service and install new gas service at approx 10' e to 13' W c/1 of 12th AVE N & 232' S c/1 of
Emerald Hills DR (1) 5x6 concrete/ Asphalt cut anticipated & (1) 3x5 paving cut 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
I x
I LF
SF
2-3 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 Exgas
❑ 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
x
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:
Are the additions for the purpose of serving new commercial development?
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 Sidock DATE: 01/25/22
APPLICANT PRINTED NAME: Susan Sidick
APPLICANT TITLE: SR Permit Specialist
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
OV
ALL
Job #:
Date:
Jurisdiction:
ROW Permit:
Est. Start Date:
Est. Duration:
109138692
9110121
Edmonds
Yes
2/14/22
2 Days (16 Hours)
Puget Sound Energy Gas Pre -Inspect Form
Address:
City / Zip:
Customer:
PM / Inspector
111 12TH AVE N
EDMONDS, 98020
SCOTT ZOLOTH 2O6-356-3248
DUSTIN WELLER 206-379-4347
Job Description / Scope of Work
From 2" STW main run complete 1-1/8 altered service (39' scat stub with 70' scat ext) Set 630 meter
New Construction:
No
OL @ Inches. Also C&C 5/8 service
at main and pull 250 meter.
Construction Method
All Scat / Trenchless
PLAT Map: 163.067
Emerald hills DR
GFR notes in red
'
N
ti-0
Utility patches shall be combined and full width or hal
1 �A
width overlay will be required depending on the exter
I 7
of disturbance. Where utility patches fall entirely witf
one travel lane, the overlay shall extend to the
I
T _
centerline of roadway- Where utility patches extend i
both travel lanes then a full width overlay is required.
52.8
I�
1/Z STRIP SVC w
Per D-= + 1304071, 5. 6 H C P E: P F-c
p I3fi S
13A S a I 1:_' S',o
L
�c
11 ��
j 112
I
_
93 . /8 ►,,;
-
3
20' .3-E
RECEIVED
j'
232'S
JAN 25 2022
fire Hydrant
10'seporafion
I
OWNER/CONTRACTOR IS RESPONSIBLE FOI
CITY OF EDMONDS
DEVELOPMENT
Main ST EROSION CONTROL AND DRAINAGE
F
SERVICES DEPARTMENT
Work Location
Size of Cut
Surface Type
10,
E
I of CL
112th AVE N
&
232'
S
I of CL
Emerald Hills DR
5x6
Concret/asphalt
13'
W
I of CL
112th AVE N
&
232'
S
of CL
Emerald Hills DR
3x5
Asphalt
of CL
I
&
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:
A630
Speed Limit:
25
No Parks #:
TBD
Steel - 1" Sery x 1/8" PE Outlet (MOP)
125 (3/4" Cutter)
Meter Loc:
03 - OL
Trolley Lines:
Mtr Hoods #:
Del Press:
6" W.C.
Traffic Signal:
Bus Stop:
Bollards:
2.5" # 4" #
I ADA Ramps #:
Applicant shall repair/replace all
ENGINEERING DIVISION
VNER/CONTRACTOR RESPONSIBLE FOR LOCATING
damage to utilities or frontage
improvements in City right-of-way
APPROVED AS NOTED
ON SITE UTILITIES. RELOCATION/REVISION TO ANY
per city standards that is caused or
UTILITIES MAY REQUIRE A SEPERATE
PERMIT.
occurs during the permitted project.
.1di WQ✓1,1,44z 02/07/2i
in
into
)22
i
TEMPORARY TRAFFIC CONTROL PLAN
of
PRINT ON
11X17" SHEETS ONLY
EMERALD HILLS DR
OV3HV
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------------------
rMERq�O y/CCS
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MAIN ST
-------------------------
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04
_______________________________________200'_________________________________
= C
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SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM
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 10' ECL of 12th Ave N & 232' SCL
of Emerald Hills DR.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
PUGET
SOUND
ENERGY
ENGINEERING DIVISION
APPROVED AS NOTED
ja LVZ,,J0,.44z 02/07/2022
VV
SIGN SPACING
MPH
"x"
60/65
1000,
45/55
500'
35/40
350'
30
200'
25
100,
Designer:
Jason Bisenius
425-424-7316
jason.bisenius@pse.com
Project Address:
111 12TH AVE N, EDMONDS, WA 98020.
RECEIVED
JAN 25 2022
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
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
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
ROW -
Puget Sound Energy
REV
Traffic Control Supervisor:
Gregory Harwood
09/15/2021
0
Card N. 012238
Card Exp.09/30/2023
Job #
g regory. h a rwood@pse.com
(425)424-6.1 It
1 109138692
1 OF 2
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t
TEMPORARY TRAFFIC CONTROL PLAN
of
PRINT ON
11X17" SHEETS ONLY
OV3HV
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avow
OV3HV o
0 03SO10 0
3NV11H16
.ZJ
0
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EMERALD HILLS DR
RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
CREW SHALL POTHOLE J I
FOR WATER MAIN DEPTH I
PRIOR TO PROJECT START
-------------------------------------------
MAIN ST
------------------------)nn,--
N
— — — — — — — — — (V -- N
bN N_---_--- —_—_
N
_______________________________________200'________________________________
D O
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W20-1
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 13' WCL of 12th Ave N & 232' SCL
of Emerald Hills DR.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
PUGET
SOUND
ENERGY
SIGN SPACING
MPH
"X"
60/65
1000,
45/55
500,
35/40
350'
30
200'
25
100,
Designer:
Jason Bisenius
425-424-7316
jason.bisenius@pse.com
Project Address:
111 12TH AVE N, EDMONDS, WA 98020.
RECEIVED
JAN 25 2022
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
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
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
ROW -
Puget Sound Energy
REV
Traffic Control Supervisor:
Gregory Harwood
09/15/2021
0
Card No. 012238
Card Ep.09/30/2023
Job #
gregory.har ood@pse.com
(425)424-0425 n
109138692
2OF2
RECEIVED
JAN 25 2022
CITY OF EDMONDS MyBuildingPermit.com
CITY OF EDMONDS
DEVELOPMENT
Right-of-EWAYKPOWtion #1081651 - 10913896392 111 12th AVE N-Emerald Hill S Dr
Applicant
First Name Last Name Company Name
Susan Sidick Puget Sound Energy- Corrosion Department
Number Street Apartment or Suite Number E-mail Address
1660 Park Lane susan.sidick@pse.com
City State Zip Phone Number Extension
Burlington WA 98233 4254576353
Contractor
Company Name
PUGET SOUND ENERGY INC
Number Street Apartment or Suite Number
1660 Park Lane
City State Zip Phone Number Extension
Burlington WA 98292 (206) 716-2641
State License Number License Expiration Date UBI # E-mail Address
PUGETSE033DD 3/28/2023 17gD 1 nns.si susan.sidick@pse.com
Project Location
Number Street Floor Number Suite or Room Number
111 EMERALD HILLS DR
City Zip Code County Parcel Number
EDMONDS 98020 00423000003800
Associated Building Permit Number Tenant Name
109138692
Additional Information (i.e. equipment location or special instructions)_
Work Location
Property Owner
First Name Last Name or Company Name
Scott M & Amy C Zoloth
Number Street Apartment or Suite Number
111 12TH AVE N
City State Zip
EDMONDS WA 98020
Certification Statement - The applicant states:
I certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further certify that I have full power and
authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such application. I
have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of work
requires a licensed contractor to perform the work, the information will be provided prior to permit issuance.
Date Submitted: 1/25/2022 Submitted By: Susan Sidick
Page 1 of 2
CITY OF EDMONDS MyBuildingPermit.com
Right -of -Way Application #1081651 - 10913896392 111 12th AVE N-Emerald Hill S Dr
Project Contact
Company Name: Puget Sound Energy- Corrosion
Department
Name: Susan Sidick Email: susan.sidick@pse.com
Address: 1660 Park Lane Phone #: 4254576353
Burlington WA 98233
Project Type Activity Type Scope of Work
Utility Purveyor Utility Work Disturbance of Surface
Project Name: 10913896392 111 12th AVE N-Emerald Hill S Dr
Description of cut and cap gas service and install new gas service at approx 10' E to 13' W c/I of 12th ave
Work: n & 232' S c/I of emeradl Hills Dr (1) 5x6 concrete /asphalt cut anticipated & (10 3x5 paving
cut anticipated
Project Details
Project Information
Job Number
109138692
Page 2 of 2