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ENG2022-0106 ROW PERMITRIGHT OF WAY EUC PERMIT PERMIT NUMBER] City of Edmonds ..• • 1 1 5th Ave N, Edmonds WA www.cityofedmonds.gov• • Description: PUD-ASSIST T-MOBILE WITH REPAIR OF ANTENNA SITE ON POLE ISSUED: 04/06/2022 Address: 21909 96TH AVE W - CELLULAR EDMONDS WA 98020-3920 EXPIRES: 10/03/2022 rmit Type: RIGHT OF WAY EUC Permit Subtype: MINOR Parcel Number: 00373600700901 i NAME TYPE NAME ADDRESS PHONE APPLICANT MOE NAVE PO BOX 1107, EVERETT WA 98206 (425)783-5681 CONTACT SNOHOMISH CO PUD 1802 75TH ST SW, EVERETT WA 98203 (425)319-4209 CONTRACTOR SNOHOMISH COUNTY PUD P.O. BOX 1107, EVERETT WA 98206 (425)670-3216 OWNER WILLIAM J HECOX 21909 96TH AVE W, EDMONDS WA 98020-3920 FEE INFORMATION DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $40.00 ENGINEERING INSPECTION FEE $110.00 $110.00 RIGHT OF WAY MINOR - EUC PERMIT FEE $110.00 $110.00 • 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 ENGINEERING DIVISION ...,7TED RELEASED BY , 1 G �n v_ , DATE /p{`�I Yv(`,/{��y 14/06/2022 Printed: Wednesday, April 06, 2022 9:31:57 AM 1 of 2 -KRWOF WAY EUC PERMIT PERMITNUMBER, City of Edmonds 06 www.cityofedmonds. ov/425.771.0220 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. MAINTAIN EROSION AND SEDIMENTATION CONTROL PER CITY AND SWMMW STANDARD ESC REQUIREMENTS 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. SCHEDULE REQUIRED INSPECTIONS AS NOTED THROUGH MY BUILDING PERMIT. INSPECTIONS www.mybuildingpermit.com POTHOLING VERIFY CLEAR BORE CROSSINGS. RESTORE LANDSCAPE Restore landscape to like or better conditions Sound or 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 AND 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 and activities must comply with the noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120. 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** Printed: Wednesday, April 06, 2022 9:31:57 AM 2 of 2 of EOMotio� RECEIVED RIGHT OF WAY CONSTRUCTION MAR 16 2022 PERMIT APPLICATION Complete and submit this Application in accordance with the Submittal CITY OF EDMONDS P pp DEVELOPMENT /'V . is') o Requirements outlined in Right -of -Way permit Handout E6�. 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 T-MOBILE EDMONDS PARKWAY REPAIR 2022 Site Address or if no site address use Property Address at NW corner of project area: 21909 96th Ave W Edmonds, WA Associated Permits: BLD PLN ENG Owner and Entity Holding Franchise (if applicable) Name of Company: Snohomish County PUD No.1 Franchise Ordinance No: N/A Point of Contact: Aziz Haq Title: Engineer Address: P.O. Box 1107 City Everett State WA Zip 982o6 Phone 425-783-5251 Email Jointuse@snopud.com Contractor and Authorized Agent of Owner Name of Company Same info as above (see note below) Contractor Contacts During Construction Primary Name Agent Name Title Title Mobile Address Email City State Zip Secondary Name Phone Title Email Mobile City of Edmonds Business License No: Email State License No: 313-005-741 ® Contractor verifies it is currently bonded ® 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 ❑ 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) ci 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.) _Work consists of troubleshooting and repairing the existing cell site. Pole is located on the east of 96th Ave W. The north bound lane shall be closed and traffic control setup per the included plan. Work will like roughly 1-day to complete. Proposed work hours of 8AM to 6PM. 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 SECTION B - If you are not a utility company performing work in the City ROW, skip to SECTIONC. T. The work in the right of way is on or for the following type of facilities: ❑ telecommunications ❑ cable ix 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. 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 utilitystem? 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? x 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: 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? 1 What is the height of the existing poles? 93 How many poles are to be removed? 0 Are additional poles to be laced? NO 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. __7 //I. APPLICANT SIGNATURE: �wC L_� DATE: 3/15/22 APPLICANT PRINTED NAME: wiz naq APPLICANT TITLE: Engineer NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 T-MOBILE EDMONDS PARKWAY - SE01575A Uz'UE 11 1818 Rev.4/19 CONSTRUCTION OPERATIONS AND ENGINEERING REQUEST TO FROM DATE KEITH ELLISON AZ1Z HAQ 425-319-4209 3/15/22 ADDRESS/LOCATION/POLE NUMBER 21909 96TH AVE W EDMONDS, WA // 25(27-3)NE // PLI: 247850 MAP NO. ORDER NO. OPERATION NO. 454-H7 100083887 40 ACTION• PLEASE ASSIST T-MOBILE WITH THE REPAIR OF THEIR ANTENNA SITE TROUBLESHOOT JUMPERS AND RADIOS, REPLACE AS NEEDED POLE HEIGHT: 93' AGL (2) HIGHLINE BUCKETS REQUIRED COORDINATE WITH KEITH ELWELL - 425-753-3458 Applicant shallities or eplace front ge OWNER/CONTRACTOR IS RESPONSIBLE FOR damage to utilities or frontage improvements in City right-of-way EROSION CONTROL per city standards that is caused or AND DRAINAGE occurs during the permitted project. f. BETWEEN 115KV SWITCHES: SL-130185A 115-1639 & 115-1656 ENGINEERING DIVISION 1135 % 1136 9TH STA-10102L63/8 1901 1 - 4 "'7TED 1 247850 _ 14/04/2022 3 270 NO EiI UIPME OR CONFIGURATION 4 909 A-45830 ALTERATIONS PERMITTED UNDER 9624 9616 2 Q 2 37 374861 THIS PERMIT. _ RECEIVED 9607 C-1$1 -18/07 615-M- G CT 121 m 21915 MAR 16 2022 22 THS 926 SL-130194-A S 130290-A SL-110462-A CITY OF EDMONDS 0 15-13187 2 1 15-13167 12-1334 DEVELOPMENT 1137 1 83 1138 1014 NSERVICES DEPARTMENT - 313 NORTH For de -energizing customer service for Customer work CUTOMEF CREW HOURS When completed, coil the PUD of 425-783-1000 Customer Signoture or (1-877-783-osk Dote for Energy Control 0Dispolch ACTIONOR OTHER ACTIONREQUIRED APPROVED BY COMPLETED BY DATE Distribution: White- lment Responsible For Work -Return To Originolor When Completed )rtment Responsible For Work -File Copy �/15/2022 1.12.57 PM Blue-GIS, 03, After Work Completion Pink-Originolor SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM LANE CLOSURE ON A TWO-LANE ROAD RECEIVED (TWO FLAGGER OPERATION) ROAD W WORK AHEAD ONE LANE W 2 0 ROAD AHEAD W20-7B • W20-7) �� zX 00 00 N M N NORTH NER/CONTRACTOR IS RESPONSIBLE FOR EROSION CONTROL AND DRAINAGE X G 2 0 - 2 ROADNWOR Applicant shall repair/replace all 4 8 r X L 4 r r damage to utilities or frontage improvements city standards City iscaus way (OPTIONAL) per city standards that is caused or occurs during the permitted project. ENGINEERING DIVISION "DTED O_Kv 14/04/2022 SNOHOMISH COUNTY EP 10= PUBLIC UTILITY DISTRICT NO 1 w W Q Ron r MAR 16 LULL CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT , -1. x 24" AL ® G20-2 x (OPTIONAL) 0 O SPACING IBNGApkE LONG 220TH AS E&ORZO JSEDE DATNE(THROUGH 22 Ce Q Z UJ a Loo X i<1 W20-7A ONE LANE i ROAD 121_ AHEAD VWORKV I f s 20-1 TRAFFIC CONTROL INSPECTION REQUIRED TRAFFIC CONTROL PLAN PROJECT T-MOBILE EDMONDS PARKWAY MODIFICATION 2021 LOCATION 21909 96TH AVE W EDMONDS, WA ENGINEER DATE 9/9/21 ORDER 100083887 PHONE W20-78 PREPARED TO STOP 4 CELLULAR