ENG2021-0078 ROW PERMITRECEIVED
.I OF EUA.1n.
INC. I sc) u
MAR 09 2021 Revision #1
ROW PERMIT NO.: ENG 2021-0078
CITY OF EDMONDS ISSUE DATE:
DEVELOPMENT
SERVICES DEPARTMENT
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 51419-5504204-97
CONTRACTOR: Pacific Cable Construction
Mailing Address: PO Box 573, Woodinville, WA 98072
State License #: 3636CON1096
City Business License #: PACIFCC954PJ
ADDRESS OR INTERSECTION OF CONSTRUCTION:
CONTACT: Traci West & Mike HaKahan
Phone #: 360-563-9000 & 425-949-0230
Fax #:
Email #: traci.west@atcotelecom.com & mike.hakahan@ziply.com
Liability Insurance 9 Bonded
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑ Single Family ❑ Other
V EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
ANY ASSOCIATED PERMITS?
❑ Yes V No
BLD# n/a ENG# n/a
DESCRIPTION OF PROPOSED WORK (Be Specific) :Telecommunications and broadband provider Ziply
nt iAnn al-,t qt gtim Ninn Fvaratt VVA ARgnR tn place service drop to existing building for customer Kroger at
22828 100th Ave W, Edmonds, WA working in the street that could impact traffic per the enclosed TCP.
No effect to hard surfaces, or vegetation.
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES ❑ NO KZ Year:
PAVEMENT CUT: ❑ Yes No If yes, indicate size of cut: x
CONCRETE CUT: ❑ Yes No If yes, indicate size of cut: x
RIGHT-OF-WAY
CLOSURE
AREA
I
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs +
LF
X
LF
SF
Alley 72 Hrs +
LF
X
LF
SF
Parking 72 Hrs +
LF
X
LF
SF
APPLICANT TO READ AND SIGN
*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 is to 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.
Indemnity: The Applicant has signed an application which states he/she hold 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 defense costs and attorney fees by reason
of granting this permit.
I have read the above statements and understand the permit requirements and acknowledge that I must
follow all requirements in order for the ermit to be valid.
SIGNATURE WNADATE 3/9/2021
Contractor or Agent
Signed by Mike HaKahan, Sr. Design Eng.
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
www.invarion.com
SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM
NOTIFY WSDOT 48-72 HOURS
PRIOR TO START OF WORK.
CONTACT BONIE NAU AT
206-440-4471
\R
\ �9
\
UTILITY
WORK
\
AHEAD
W21-7
350' RIGHT
LAN
PLACE SIGN
ON ROADS
ROAD
WITHIN 100'
WORK
AHEAD
OF WORK
ZONE
W20-1
Legend
°41A Bucket truck
Ocone
Flagger
OW-122 Right lane closed ahead
® Pole
OW20-1 road work ahead
W20-7A Flagger Ahead
O W20-7b be prepared to stop
W21-7 utility work ahead
II W4-2 road narrows
Manifest
W4-2 ` \
� o �
BE O \
350, PREPARED \
TO STOP \ \
W20-7b
350'
o \
0
W20-7A °\ `
a
ob \
a
• oo
0
REQUIRED Q
O. \
WORK HOURS - OFF PEAK ONLY
M-F9AMTO3PM
NO FEDERAL HOLIDAYS.
PAW 1 CJ.
1. MAINTAIN PED. ACCESS TO
AND THROUGH CROSSWALKS
2.MAINTAIN MIN 11' LANES
3.MAINTAIN LOCAL ACCESS
4.NOTIFY TRANSIT AUTHORITY
T LEAST 48HRS. IN ADVANCE
OF BUS STOP CLOUSRE
5.TRAFFIC CONTROL PLAN AND
DEVICES SHALL COMPLY WITH MUTCD,
PROWAG &WSDOT
6.DEVICE SPACING
FLAGGER TAPER 20'
SIGNS PER WSDOT
TAPERS PER WSDOT
7.28" CONES
36" BARRELS
8" SIGNS
4" PADDLE
&ADJUST TO FIELD CONDITIONS
77 x cone
10 x Sign Stand
4 x Arrowboard (Chevron)
2 x OW-122 Right lane closed ahead
2 x truck
2 x W20-1 road work ahead
2 x W20-7A Flagger Ahead
2 x W20-7b be prepared to stop
2 x W21-7 utility work ahead
2 x W4-2 road narrows
K&U SEKVIUI=b , AS I HE HKEHAKEK OF I HIS I KAFFIU
CONTROL PLAN MAKES NO REPRESENTATION AS TO ITS'
GENERAL ADEQUACY OR BEING APPROVED FOR IMPLEMENTATION.
APPROVAL MUST RESULT FROM TRAFFIC ENGINEER OR OTHER
PUBLIC OFFICIAL HAVING STATUTORY ENFORCEMENT AUTHORITY
IN THE JURISDICTION. UTILIZATION & IMPLEMENTATION OF THIS PLAN
SHALL BE A RESULT OF THAT APPROVAL.
REF. MUTCD 2009 6A-01(10)
Applicant shall repair/replace all
damage to utilities or frontage
improvements in City right-of-way
per city standards that is caused or
occurs during the permitted project.
S
NOT TO SCALE
NOTIFY EMS, FIRE
AND POLICE
72 HOURS IN ADVANCE
PLEASE SCHEDULE
WITH DISPATCH
@800-343-4049 OPTA
AND PROVIDE A
COPY OF THE APPROVED
TRAFFIC CONTROL PLAN
/-- REQUIRED
350'
\°
o PLACE SIGN
°\ o W20-7A BE ON ROADS ROAD
PREPAREWORK
off\ \ TO STOP 350' WITHIN 100'
D AHEAD
OF WORK
\ \ ZONE
` \ \ W20-7b W20-1
\ I 350'
\ \ \ <R>
350'
W4-2
\ \ UTILITY
\ OW-122 HEAD
\ \
\ W21-7
CUSTOMER:
ATCO
CONTACT: VICTORIA COMER
830-513-6614
LOCATION:
22828 100TH AVE W
EDMONDS, WA
DATE: W/O #
03/05/21 5504204-97
ElK & D SERVICES
TRAFFIC MANAGEMENT
DESIGNED BY.ISAIAH MARTINEZ
OFFICE.800-343-4049
CELL:425.530.9162�"
WATCP@KNDSERVICES.NET WSTCS#011748
OWNER/CONTRACTOR IS RESPONSIBLE FOR
EROSION CONTROL AND DRAINAGE
FpMo�� wqY � R
a F
y
ENGINEERING DIVISION
...,7TED
p( 6-)4 12/18/2022
RECEIVED
MAR 09 2021
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM
PLANNING NOTES:
Ethernet over Fiber (Non SES/GPON)
***OSPREVW ******ETHERNET OVER FIBER***
OSP Construction Required: Yes Description of Work: Splice fibers, run red jumper in H5014, and extend fiber to customer location for new fiber fed RAD
NID.
VARASSET TICKET#: N/A
INFINIUM ESTIMATE ID: N.A
VARASSET WO: 5504204-97
Existing Nid CLLI: N/A
SWC: Halls Lake
FIBER ASSIGNMENT: FC1031,382 leaving the Halls Lake CO on FDF 011, Panel 11, Connector 22, coming into H5014 on connector 10 leaving H5014 on
connector 350 and riding distribution fiber H5014,350 into new fiber terminal on connector 2.
Loop Makeup: 11,100'
OSP ENGINEER: Mike Hakahan
Estimated Release to Construction Date: 3/2/2021
Estimated In Service Date: 4/23/2021
Single or Multi Tenant Building:
DEMARC/Site walk Notes: We will terminate in the MPOE and handoff in the Server room as the customer requested an extension. I will get that process
started.
Bulk WO# 5504204-97 - HLLK - 20M - ASR# 3385655 - Kroger - 22828 100th Ave W, Edmonds
LCON:
ERIN BURWELL 503-468-7152
ERIN.BURWELL@KROGER.COM
ALCON:
GLENN AMMONS 425-409-9641
GLEN.AMMONS@KROGER.COM
Applicant shall repair/replace all
damage to utilities or frontage
improvements in City right-of-way
per city standards that is caused or
occurs during the permitted project.
I CERTIFY THAT THE WORK I COMPLETD ON THIS WORK ORDER
AND AS -BUILT IS IN COMPLIANCE WITH FRONTIER QUALITY
STANDARDS AS IDENTIFIED ON THE IPQIP CHECKLIST.
(SIGNATURE AND DATE)
TOTAL ALLOTTED HOURS
CONTACT SUPERVISOR IF ADDITIONAL
HOURS ARE REQUIRED TO COMPLETE PROJECT
CAP. X-TIME MAINT
CREW 1 0 0 0
SPLICING 1 0 0 0
W.O. DRIVER CONSTRUCTION START
® ETHERNET 3/1/21
❑ CIAC IN SERVICE DATE
❑ DAMAGE 4/23/21
❑ OTHER
CONSTRUCTION
❑ FLAGGING ❑ BRUSHING ® CONTRACTOR
PERMITS
MUNICIPALITY: CITY OF EDMONDS
❑ BLANKET
o TCP/TRAFFIC
® DETAILED (NOT BLANKET)
❑ NO PERMIT REQUIRED
JOINT POLE
JFN/NJUNS#
® NO JPN REQUIRED
POLE JPN
JPN
OWNER TO
FROM
❑ ❑
❑ POWER
❑ ❑
❑ CATV
❑ ❑
❑ FRONTIER
ACCOUNT CODES
❑ 2411.001 POLES
❑ 2422.201 UG FIBER
❑ 2421.101 OH COPPER
❑ 2441.001 CONDUIT
❑ 2421.201 OH FIBER
❑ 34XX.XXX REMOVAL
❑ 2422.101 UG COPPER
❑ 64XX.XXX MAINT.
SITE CONTACT: JOSE PEREZ
602-825-5798
SCHEDULING:
JOHN WOOD
PHONE:
425-261-1412
ENGINEER:
MIKE HAKAHAN
PHONE:
425-949-0230
FACILITIES:
EUNICE RIMANDO
PHONE:
425-263-4009
FIELDED BY:
DONAVON LAFLEUR
T"re1
ENGINEERING DIVISION zipyrner
OWNER/CONTRACTOR IS RESPONSIBLE FOR "^^^^"r^ "^ " )TED RECEIVED
EROSION CONTROLAND DRAINAGE
_ llo w 12/18/2022 MAR 09 2021
j�
ill
HLLK - 20M - ASR#3385655 - KROGER
22828 100TH AVE W, EDMONDS
CITY OF EDMONDS
PROJECT 550420497
NUMBER: -
C.O. AREA: 962
EXCH. CODE: 51419
DRAWN DATE:
ENGR: M. HAKAHAN
CNTY: SNOHOMISH
DEVELOPMENT
SERVICES DEPARTMENT
3/1/21
PHONE: 425-949-0230
FILE:
SCALE: 1:100
TAX DISTRICT:
I DWG 1 OF 2
TWNSHP: 27N
RNG: 5E
I SEC: 36A
N
RED JUMPER\
FC1031, 382
TO H5014,350
HLLKWAXX H5014,_
FDH 48/432
IN: HLLKWAXX FC1031,373-383+
XD,384-386+
XD,15-24
OUT: HLLKWAXX H5014,1-432
IN: HLLKWAXX FC1031,373-383+
XD,384-386+
XD,15-24
OUT: HLLKWAXX H5014,1-349+
HLLKWAXX FC1031382+
HLLKWAXX H50�3�32
RECEIVED
MAR 09 2021
CITY OF EDMONDS
QEVFI OPMENT
SERVICES DEPARTMENT
0 HLLKWAXX FT-383703
IN: HLLKWAXX FC1031,386+
\\ XD,2-4
OUT:
g Awl
low
rm All fti, 4 * "N ,
I \,74-0 11.2008 `
RBN 96
HLLKWAXX H5014,277+
HLLKWAXX FC1031,384+
HLLKWAXX H5014,279-360+
XD,85-96
HLLKWAXX H5014,277+
HLLKWAXX FC1031,384+
HLLKWAXX H5014,279-349+
HLLKWAXX FC1031,382+
HLLKWAXX H50i4,351-360+
XD,85-96
4231 11.2007 I \
RBN 144
HLLKWAXX FC1031,349-390+
XD,43-78+
\ XD,79-144
\
\ P21
P U D\t1
N \ \
LLKWAX 8110J 2-9
IN: HLLKWAXX 78-360+ PUD #1
XD,4 �^
OUT:
P25
2-8
PUD
10124 EDMONDS WA
I
PLACE NEW TERMINAL TAIL FROM POLE(P26)
ACROSS EDMONDS WAY TO POLE(P26S2). EXTEND
FIBER DROP DOWN RISER IN EXISTING CONDUIT
TO TERMINATE IN MPOE FOR EXTENSION TO
FRONT OF STORE FOR HANDOFF TO RAID NID.
0117 EDMONDS WAY
LLKWAXX 101685
IN: XD,1+
HLLKWAXX H5015,14-18+
HLLKWAXX FC1031,299-31
XD,9-12
HLLKWAXX H5014,3 9+ OUT:
HLLKWAXX FC1031 82+
XD,3-6
P13
(FTTP PIGTAIL 200 6 -7
(HLLKWAXX H5014,3 9-350+
�XD,3-6 ) i9\/
210'
110' AKF 25 24
E 50 24 -
C95ES DCS,1151-12 0 220'
E 25 24
C95ES DCS,1151-1175
�GKROGER
cIVPHS2 22828 0PUD0th Ave W
I CERTIFY THAT THE WORK I COMPLETD ON THIS WORK ORDER
AND AS -BUILT IS IN COMPLIANCE WITH FRONTIER QUALITY
I
STANDARDS AS IDENTIFIED ON THE IPQIP CHECKLIST.
(SIGNATURE AND DATE)
TOTAL ALLOTTED HOURS
CONTACT SUPERVISOR IF ADDITIONAL
HOURS ARE REQUIRED TO COMPLETE PROJECT
CAP.
X-TIME
MAINT
CREW
0
0
0
SPLICING
0
0
0
W.O. DRIVER
CONSTRUCTION START
Ij
li®
ETHERNET
3/1/21
IN SERVICE DATE
❑ CIAC
I I
❑ DAMAGE
4/23/21
Ji❑
r�
I
OTHER
CONSTRUCTION
I
I I
I
❑ FLAGGING ❑ BRUSHING ® CONTRACTOR
I
I
PERMITS
j I
MUNICIPALITY: CITY OF EDMONDS
❑ BLANKET
In TCP/TRAFFIC
® DETAILED (NOT BLANKET)
❑ NO PERMIT REQUIRED
JOINT POLE
I
JFN/NJUNS#
\ UNK-SERVICE DROP 1
\ HLLKWAXX FC1031,382
BEFORE RED JUMPER
HLLKWAXX 531702 i Q
IN: HLLKWAXX H5014,349-350
\I XD,3-6 I o
F� OUTe
\ O o
AFTER RED JUMPER �-
E642 `LOSS IN:HLLKWAXX H5014,349+ I 3:
\y� HLLKWAXX FC1031,382 Ld
\ XD,3-6 I Q
OUT: _
to
C® I
I
1 ,
® NO JPN REQUIRED
POLE JPN JPN
OWNER TO FROM
❑ ❑ ❑ POWER
❑ ❑ ❑ CATV
❑ ❑ ❑ FRONTIER
ACCOUNT CODES
❑ 2411.001 POLES ❑ 2422.201 UG FIBER
❑ 2421.101 OH COPPER ❑ 2441.001 CONDUIT
❑ 2421.201 OH FIBER ❑ 34XX.XXX REMOVAL
❑ 2422.101 UG COPPER ❑ 64XX.XXX MAINT.
SITE CONTACT: JOSE PEREZ
602-825-5798
SCHEDULING:
JOHN WOOD
PHONE:
425-261-1412
ENGINEER:
MIKE HAKAHAN
PHONE:
425-949-0230
FACILITIES:
EUNICE RIMANDO
PHONE:
425-263-4009
FIELDED BY:
DONAVON LAFLEUR
• I T.rI
zipiyrir)er_
HLLK - 20M - ASR#3385655 - KROGER
22828 100TH AVE W, EDMONDS
PROJECT I C.O. AREA: 962
NUMBER: 5504204-97 EXCH. CODE: 51419
DRAWN DATE: ENGR: M. HAKAHAN CNTY: SNOHOMISH
3/1/21 PHONE:425-949-0230 FILE:
SCALE: 1:100 TAX DISTRICT: DWG 2 OF 2
TWNSHP: 27N RING: 5E SEC: 36A