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ENG2022-0107 ROW PERMITOF WAY EUC PERMIT PERMIT NUMBER City of Edmonds AveRIGHT ••• • 1 1 1 www.cityofedmonds.gov• • Description: PUD-REPLACE BO POLE ISSUED: 04/12/2022 Address: 17315 72ND AVE W EDMONDS WA 98026-5103 EXPIRES: 10/12/2022 rmit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00513100013801 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)239-8210 CONTRACTOR SNOHOMISH COUNTY PUD P.O. BOX 1107, EVERETT WA 98206 (425)670-3216 OWNER DONALD RICHARD TTEE WALKER 17315 72ND AVE W, EDMONDS WA 98026-5103 FEE INFORMATION DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $40.00 RIGHT OF WAY STANDARD - EUC 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 04/12/2022 RELEASED BY DATE Printed: Tuesday, April 12, 2022 2:03:10 PM 1 of 2 -KRWOF WAY EUC PERMIT PERMIT NUMBER City of Edmonds 121 5th Ave N, Edmonds ...• • 1 1 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 X-2 ENGINEERING FINAL** Printed: Tuesday, April 12, 2022 2:03:10 PM 2 of 2 of ED/q() RIGHT OF WAY CONSTRUCTION PERMIT APPLICATION Complete and submit this Application in accordance with the Submittal �Ne. 1390 Requirements outlined in Right -of -Way permit Handout E6,�. If any field is not applicable to your project, write "NJAV, ,#)#=A,f Jf*ving blank. All fields required. Incomplete Applications wiWlcd(dell. ZZOZ L � JeA SEMONA a3AI333H General • Project Name d /C.LQ(- �b Lo Site Address or if no site address use Property Address at NW corner of project area: 2�V pe w Associated Permits: BLD PLN ENG 'YCJ l cv,�S`i'e_cnr� Entity Holdingapplicable) -Ownerand Name of Company J , "a CuFranchise Ordinance No: N/A Point of Contact V o Z;=U Title S 2 a S Address fro '7 rr( S'r S IN City V t� State (,u Zip 2U 3 Phone L 2- 7 9 3 ' 0 SS' Email e Contractor and Authorized Agent of Owner (see note below) Name of Company ��/ Cuc2� Contractor Contacts During Construction Primary Name Agent Name A4 Title Title ., eel Mobile L _ Address 'Z C t �w �� Email LPS f f� C C City R State Zip z� Secondary Name Phone ZS_ 76 ? _ gTsq Title Email ` r �{, % ,Vv Nei Mobile City of Edmonds BusinessLicenseNo: Email State License No: , /_? — 00-5'— =i Contractor verifies it is currently bonded i Contractor verifies it currently has general liability insurance NOTE: ECDC18.6o.020 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) Xtraffic Control Only (no associated development) Atility 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.) �• �JIYJ Cre- 1 r-e- t:� (a La � j) 13A✓� o(&_e^ �/ �vt.-v)G..� Po w z_ U CAe- -0 Lk .�_( 22 �-��/� 4 C� a 4 1`1U fntts 1 A• �1Ur j-1�� 4, 1 mow. - RIGHT-OF-WAY CLOSURE AREA TOTAL DURATION (Number of Months) Sidewalk 72 hours + LF xJ F SF <�) Alley 72 hours + LF x LF SF Parking 72 hours + I LF xJ LF SF t� SECTION B - If you are not a utility company performing work in the City ROW, skip to SECTION C. Type of 7. The work in the right of way is on or for the following type of facilities: ❑ telecommunications ❑ cable empower ❑ gas ❑ water ❑ sewer ❑ storm Details of Work to be Completed Yes No i. I Does the utility owner have existing overhead infrastructure in the area of work? 2. 1 Will any equipment be added underground or above ground (e.. 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 stem? \ l J� 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? I Details of Work to be Completed I Yes No 6. Does your project involve rebuilding or replacing utility equipment which currently serves more than one lot or commercial development? L1 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? How many are to be added? L> City of Edmonds ROW construction permit Application --Page 2 of 3 Updated 3/25/2021 6b. Does your project involve poles? If yes: How many poles are existing in the project area? 1 What is the height of the existing poles? How many poles are to be removed? Are additional poles to be laced? How many? What is the height of the additionalpoles? 6c. Are any poles to be modified/rebuilt/replaced? If yes: How many? I I I What is the height of the poles after? Describe the modification rebuild: It. Is, A l aiv 7, 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: NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 N I \`V `I V `V KAl it 17 7n77 7 SERVICES APPROVED AS NOTED 30 133HS DEVELOPMENT �"' EDEPARTMENTVI /2 USSO-3 Applicant shaUx€.paix/r€plac�-- u---------- ____ damage to utilities or fronts improvements in City per city stand ds that is caused o ; Ol Ol occurs during the, mitted rojectQ' �� d-66Tt 1S 0 � if C 9I 9££L I£Li b WNER/C TOR 1 NSIBLE FOR Z EROSION COLD GE LOl O NER/CWTgtA IRESP IBLE FOR ALL N SITE UTILIT S. RELO ATI UTILITIES MAY RE bIRE P SEPERAT l £0£Li d- b8Zi-1S i TING SIN OliVh3HOS - PUD TO ENFORCE POLE ATTACHMENT AGREEMENT. - PUD IS RESPONSIBLE FOR ENSURING THAT THE OLD POLES IS REMOVED. a38=38 X80M 3381:310N SdVW 01. IV NY4JX 3Sn3 A 03S #83S -S*L2 #oin 0OZL/0t1Z/0ZL 8W3X VAX9*L£ Hdl V ONVH DVI NOIInVO NO S,80d 103dsns mvv4 WUX NO OVl NOIInVO aw 0V8 HV4JX 11VISNI #83S 8999-5'L£ 8hJX AW2i S,OAS 03S aHAO 833SNVNI bSOVZ# S801OnaNOO In3N/18d 633SNV8i L093ZL (INV LOZ3Zl-SO 83d 310d 3WVHJ d330 135'9 310d 13S 310d ONIISIX3 30 'S'I 310d 135V 13S :S310N W iona1SN00 ; In3N 8SOVZ#(0 18d ?JSOVZ#(Z) I Z6-Zl A23d Z l OIZ8-65�Z it • �-133 S.8DN3 6999-£8L-5Zi7 . 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S3A0 0,038 S33J WOWS 0313ldw0o WJOM 31VO 031NIdd 31VO 'F-03AOa l - „l 3')V3S dV 'ON '3'n 8313Vaa t — Nd and 05�00 N0I1YS3d0 331H V a33NION3 N 3 310d 830HO OV 3Z)V1d3W)1vO1A 803 NOSV38 830ao / 1/ 31V0 1708 L I SOSWIMS Z/L17 'ON 310d V38VOOOMNNAI M 3" 0 ZL 9LCLL No11V3o1 A1Nn03 NSI140HONS 30 I'ON 13181S10 A11111n 3118nd SCHEDULE ALL INT10 S THI 1N3W1NVd3a LANE CLOSURE ON AS39)MtA1`IE ROAD (TWO FLAGGER Oego6TAPWA W20-1 WOA D 1333H AHEAD XF I ONE LANE W20-4 ROAD AHEAD X W20-7A X Za 5m 00 N rM X G2 0 — 2 1 ROAD WORK E 48" x 24" (OPTIONAL) 0 0 0 48" x 24" G20-2 ROAD WORK X (OPTIONAL) 0 0 IJ. N Mx LLJ Lc)o X ST W20-7A X ONE LANE = ROAD W20-4 AHEAD X ROAD = WORK W20-1 AHEAD W20-7B BE PREPARED TO STDP OPTIONAL IF 40 MPH OR LESS ZZOZ/LO/b0 GDi0N S`d G3IAMJdd`d NOISIAIG ONI J33NIJN3 RECEIVED Mar 17 2022 CITY OF EDMONDS CITY OF EDMONDS MyBuildingPermit.com DEVELOPMENT SERVICES DEPARTMENT Right -of -Way Application #1109274 - WO 100092602 Applicant First Name Last Name Company Name Moe Nave Snohomish County PUD Number Street Apartment or Suite Number E-mail Address PO Box 1107 jointuse@snopud.com City State Zip Phone Number Extension Everett WA 98206 4257835681 Contractor Company Name Owner Number Street Apartment or Suite Number City State Zip Phone Number Extension State License Number License Expiration Date UBI # E-mail Address Project Location Number Street Floor Number Suite or Room Number 17315 72ND AVE W City Zip Code County Parcel Number EDMONDS 98026 00513100013801 Associated Building Permit Number Tenant Name Additional Information (i.e. equipment location or special instructions)_ Work Location Property Owner First Name Last Name or Company Name Donald Richard Ttee Walker Number Street Apartment or Suite Number 17315 72ND AVE W City State Zip EDMONDS WA 98026-5103 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: 3/17/2022 Submitted By: Moe Nave Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Right -of -Way Application #1109274 - WO 100092602 Project Contact Company Name: Snohomish Co PUD Name: Andrew Rife Email: ASRife@SNOPUD.com Address: 1802 75th St SW Phone #: 4252398210 EVERETT WA 98203 Project Type Activity Type Scope of Work Utility Purveyor Utility Work Disturbance of Surface Project Name: WO 100092602 Description of Work: Replace bad order pole Project Details Project Information Job Number 100092602 Page 2 of 2