REVIEWED BLD2020-0679+ROW+4.14.2021_10.40.38_AM+2144831_4 of ELIAjnn
Nc. I $90
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROTECT NAME:
CONTRACTOR:
Mailing Address:
State License #: d_TT
City Business License #:
CONTACT:
Phone #: 2 7J uz�
Email #: � . rye V 1 c4t( e 5�, r
au � c.aak, a-`1
Liability Insurance ["Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: I F71 j 9-&t—'Lc
RQW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
LJ Commercial U Subdivision ❑ City Project Traffic Control {Only)
❑ Multi -Family ❑ Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
ANY ASSOCIATED PERMITS?
❑ Yes ❑ No
BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : �l ruc -ew
CdJ�
oa C
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES NO 2 Year:
0P+vK
PAVEMENT CUT: dyesEl No If yes, indicate size of cut: � �f a` f
CONCRETE CUT: ❑ Yes ET"&o If yes, indicate size of cut: x
RIGHT-OF-WAY
AREA
CLOSURE
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
control and public safety shall be in accordance with City regulations as required by the City
er. Every flagger must be trained as required by (WAC) 296-155-305 and must have certification
ag completion of the required training in their possession.
Won is to be in accordance with City codes and Standards. All street -cut trench work shall be
with asphalt or City approved material prior to the end of the workday — NO EXCEPTIONS.
Ind mnity: 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.
read the above statements and unde • i tithe permit requirements and acknowledge that I must
all requireme in o die r to be valid.
4TURE 'ev, &5r-11G DATE
Contracto r Agent l e LLG
zT-
-Wopel,
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE