ENG2022-0165 ROW PERMITRIGHT OF WAY EUC PERMIT
PERMIT NUMBER
City of Edmonds
98020ENG2022-0165
www.cityofedmonds.gov
Description: PSE - LEAK REPAIR W/ SOFT SURFACE CUTS ISSUED: 04/18/2022
Address: 8725 MADRONA LN EDMONDS WA 98026-8653
EXPIRES: 10/18/2022
Permit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00504700101500
iiiI 11-14111 a
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 BRUCE P WITENBERG 8725 MADRONA LN, EDMONDS WA 98026-8653
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
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
04/18/2022
RELEASED BY
DATE
Printed: Monday, April 18, 2022 2:37:35 PM 1 of 2
-KRWOF WAY EUC PERMIT
City of Edmonds
•:• •ENG2022-01651
. -. 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**
E-7 RESTOR LIMITS
Printed: Monday, April 18, 2022 2:37:35 PM 2 of 2
of EpM04O�
/'Vc. i Ba 3
SECTION A
RIGHT OF WAY CONSTRUCTION
PERMIT APPLICATION
Complete and submit this Application in accordance with the Submittal
Requirements outlined in Right-of-Wgy permit Handout E6�.
RECEIVED
Apr 18 2022
CITY OF EDMONDS
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.
General •
Project Name 8/87037342
Site Address or if no site address use Property Address at NW corner of project area: 8725 Madrona Ln
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 ❑ Single family -other ❑ Industrial
❑ Demo and rebuild or from vacant land?
cvOther, please specify: Leak Repair
❑ 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.)
Leak repair at tie in apnrox 12123_9' N c/l of Madronna Ln & 18' E c/l of 88th AVE W (1) 4x5 soft surface gravle cut
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 SECTION C.
1. The work in the right of way is on or for the following type of facilities:
❑ telecommunications ❑ cable ❑ power Xgas
❑ 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.)?
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:
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?
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? 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 Sidick DATE: 04/14/22
APPLICANT PRINTED NAME: Susan Sidiev
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
Job #: 887037343 PRE -INSPECTION REPORT ® PUGET SOUND ENERGY
Date Received: 12/09/2021
Jurisdiction: Edmonds
Right of Way Permit? 0 YES []NO
First Poss Start: 15D
First Poss Comp: 151)
Address: 8725 Madrona Lin RECEIVED
City / Zip: Edmonds 98026
Cust Name: Apr 18 2022
Customer Email: CITY OF EDMONDS
BEYEEOP VICES
PM / Insp: Project Managers DEPARTMENT
Job Description / Scope of Work:
ILeak Repair
Est. Job Duration: 8 hrs
NEW CONST:
❑ YES ❑✓ NO
LEAK repair at tie in for 2" PE gas main to the 2" STW gas main.
IFS / PSE Dig
LEAK #N0130373
Service Work — No Stub Ftg: Ext Ftg: Tot Svc Ftg:
0'
Main Ext Work — No
PLAT MAP# 166 068 FIELD INSPECT-M.I.W.ON: 12/09/21
BY:
t
N
234th St SW
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OWNER/CONTRACTOR IS RESPONSIBLE FOR
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2" STW IP
Applicant shall repair/replace all EROSION CONTROL AND DRAINAGE
damage to utilities or frontage
improvements in City right-of-way
per city standards that is caused or OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING
occurs during the ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY
I
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18'E C/L
3036-1961
permitted project.
UTILITIES MAY REQUIRE A SEPERATE PERMIT.
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'Or
0
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OVWSD HYDRANT IN
2" MPEI-7 IP gas main
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VICINITY OF WORK. IF
129' N C/L 107059126-2019 JT
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DIGGING WITHIN 10' of
HYDRANT.CONTACT
a O o 0 0 o d o 0 0 0 o D o
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OVWSD AT 425-774-7769
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AREA OF LEAK
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RESTORATION LIMITS TO BE DETERMINED
I
BY CITY ENGINEERING INSPECTOR
v
O 8725
ANY CUTS IN THE ROAD SHALL REQUIRE ADDITIONAL
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INSPECTION FEES AND SHALL BE SUBJECT TO CITY'S
H I 3 I
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RESTORATION REQUIREMENTS.
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Utility patches shall be combined and full width or half
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width overlay will be required depending on the extent
of disturbance. Where utility patches fall entirely within
one travel lane, the overlay shall extend to the
i
2" PE IP as main
centerline of roadway. Where utility patches extend into
I I
12' Madrona Ln
both travel lanes then a full width overlay is required.1
O 900180
MADRONA LN
W (234TH PL 5W)
Work Location
Size of Cut
Surface Type
129' N of CL Madrona Ln & 18' E of CL
88th Ave W
4 x 5
soft surface/gravel
of CL & of CL
of CL & of CL
❑✓ FLAGGERS #: 2 25 MPH ❑ TROLLEY LINES ❑ BUS STOP #:
❑ METER HOODS #:
❑ OFFICERS #: SPEED LIMIT ❑ TRAFFIC ❑ ARTERIAL
❑✓ NO PARKS #: 4
WORK TYPES Pipe
Size
EFV'S
Meters QQt _. Pressure
Misc Meter Stuff
STUB ❑POTHOLE
❑COMMERCIAL ❑ ❑
❑5/8"
1/2"
❑775
❑250
❑ Templ Bar Size:
❑EXTENSION ❑MAIN MAINT. ❑
3/4"
❑ 1800
_
❑6��wc
❑J RESIDENTIAL
❑ COMPLETE ❑
11/8"
❑ 2600
❑425
❑2#
❑ Bollards 2.5" #:
❑❑SERV MAINT. MULTI -FAMILY ❑ TWIN ❑
11/4"
❑ 10,000
_
❑630 ❑- 5#
❑ Bollards 4" #:
VALVE MAINT. ❑2"
❑NEW CONST. ❑ ALTER COMM SVC [-]VALVE
4"
N/A
_
Fuel Line Permit
El
❑ ALTER RESID. SVC ❑LEAK REPAIR
❑ 1000
Fuel Line Length:
❑❑ CUT & CAP SERVICE REPL. ❑CP WORK ]6"
8"
Mtr LOc:
Fuel Line Diameter:
TEMPORARY TRAFFIC CONTROL PLAN
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ENGINEERING DIVISION
...,7TED
� ()4U 14/18/2022
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.
OWNER/CONTRACTOR IS RESPONSIBLE FOR
EROSION CONTROL AND DRAINAGE
234TH S TSW
W a
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OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING
ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY
UTILITIES MAY REQUIRE A SEPERATE PERMIT.
RESTORATION LIMITS TO BE DETERMINED
BY CITY ENGINEERING INSPECTOR
W20-1
Utility patches shall be combined and full width or half
width overlay will be required depending on the extent
of disturbance. Where utility patches fall entirely within
one travel lane, the overlay shall extend to the
centerline of roadway. Where utility patches extend into
both travel lanes then a full width overlay is required.
Notes:
1. All signs and spacing to conform to the
MUTCD and City of Edmond 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 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 129' NCL of Madrona Ln & 18'
ECL of 88th Ave W
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MAPLE LN
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RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
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PLACE SIGNS
BOTH SIDES OF
WORK AREA
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C� � W 3-4
S
NE
CD
SIGN SPACING
MPH
"x"
60/65
1000,
45/55
500'
35/40
350'
30
200'
25
100,
PUGET Designer:
SOUND Kali-Jamal Collins
ENERGY 425-424-6425
Kali-Jamal.Collins@pse.com
Project Address:
8725 Madrona Ln, Edmonds, WA
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
Puget Sound Energy
Traffic Control Supervisor:
Gregory Harwood
Card No. 012238
Card Exp. 09/30/2023
RECEIVED
Apr 18 2022
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
LEGEND
®
28" TRAFFIC CONE
®
WORK PIT
TRAFFIC FLOW
FLAGGER
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
ROW
REV
12/22/2021 0
Job #
887037343
1 OF 1