ENG2022-0063 ROW PERMITRIGHT OF WAY PERMIT
PERMITNUMBER,
City of Edmonds
_7 121 5th Ave N, Edmonds WA ..• • 1 11.11
www.cityofedmonds.gov• •
Description: PUD POTHOLING FOR CITY PHASE 9 SEWER PROJECT ISSUED: 02/22/2022
Address: 121 5TH AVE N EDMONDS WA 98020
EXPIRES: 02/17/2023
rmit Type: RIGHT OF WAY Permit Subtype: CITY Parcel Number: 00434400100300
i
NAME TYPE NAME ADDRESS PHONE
APPLICANT MOE NAVE PO BOX 1107, EVERETT WA 98206 (425)783-5681
CONTACT RICHARD DUMO PO BOX 1107, EVERETT WA 98206 (425)783-5110
CONTRACTOR SNOHOMISH COUNTY PUD P.O. BOX 1107, EVERETT WA 98206 (425)670-3216
OWNER EDMONDS CITY OF 250 5TH AVENUE N, EDMONDS WA 98020
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
1111
•
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
ENGINEERING DIVISION
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RELEASED Bl 1 //) _ ,.. DATE
12/22/2022
Printed: Tuesday, February 22, 2022 1:05:56 PM 1 of 2
KIRRMF WAY PERMIT
City of Edmonds
www.cityofedmonds.gov• •
CONDITIONS
CONDITION TYPE
ALERT RESIDENTS
Alert affected residents and/or businesses prior to work start.
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.
INSPECTIONS
Scheduled required inspections as noted through My Building Permit www.mybuildingpermit.com
POTHOLING
Verify clear bore crossings.
RESTORE LANDSCAPE
Restore landscape to like or better conditions.
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
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.
•
INSPECTION TYPE DATE RESULT NOTES
COMPLETE
X 2 ENGINEERING FINAL**
Printed: Tuesday, February 22, 2022 1:05:56 PM 2 of 2
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.)
Scope: Perform potholing at stated address to find electrical service conduits that might be in conflict with the City's Sewer replacement project.
(as requested by Russell Lynch - 425-771-0220 ext. 1701)
RIGHT-OF-WAY
CLOSURE
AREA
TOTAL
DURATION
(Number of Months)
Sidewalk 72 hours +
LF
I x
LF
SF
n/a
Alley 72 hours +
LF
Ix
I LF
SF
n/a
Parking 72 hours +
LF
I x
I LF
SF
n/a
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 X 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. 1 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 existingunderground common utilitysystem?
X
5.
Does the work involve proposed additions to an aboveground utility system? If es:
X
Are the additions for the purpose of serving new commercial development?
n/a
Are the additions for the purpose of serving a single-family residential subdivision?
n/a
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?
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:
APPLICANT PRINTED NAME:
APPLICANT TITLE:
Ie 11wo
Richard Dumo
PUD Engineer
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
DATE: 2/16/2022
City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021
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FEB 16 2022
OWNER/CONTRACTOR IS RESPONSIBLE FOR
EROSION CONTROL AND DRAINAGE
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
SNOHOMISH COUNTY
L r-
TRAFFIC
CONTROL PLAN
PUBLIC UTILITY DISTRICT NO 1
PROJECT POTHOLE FOR PUD SERVICE CONDUITS
LOCATION 7411 241ST ST. SW, EDMONDS WA 98026
ENGINEER RICHARD DUMO DATE 2/16/2022
ORDER 100076076-60
PHONE 425-783-5110
CELLULAR 425-346-8846