111 Sunset - Right of Way -permit app;01F E 1'tD
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
4vc• ,r90 PERMIT APPLICATION
PROJECT NAME: 1�60¢A/ICIF-
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CONTRACTOR: r`'11 ma's Pwkm 3 i NG ,
I Mailing Address: PO BoK l s35
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State License #: M I
City Business License #:
CONTACT: F-YA-N 4 Ca(=, t tj s
Phone #: 2�. 19 4. 1S t 8
Fax #: N 1 A
Email#: pf{z�GvMtSp�ctw�btv�ga
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Liability Insurance Bonded
RESS OR INTERSECTION OF CONSTRUCTION: f j �NSF_r a _E- ' D
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W WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial EJ Subdivision ❑ City Project ❑ Traffic Control (Only)
Multi -Family ❑ Single Family ❑ Other
J EUC (PUD, VERIZON, PSE,
`OMCAST, OVWSD):
this permit part of a blanket permit? ❑ Yes ❑ No
ANY ASSOCIATED PERMITS? I F—BLD#— ENG#
ESCRIPTION OF PROPOSED WORK (Be Specific) : C oL,_+
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P
AS STREET OVERLAYED WITHIN THE LAST FIVE 5) YEARS? YES ❑ NO n Year:
PAVEMENT CUT:
❑ Yes
❑ No
If yes, indicate size of cut: x
CONCRETE CUT:
0
Yes
❑ No
If yes, indicate size of cut: -t4-+ —x—(I ft
RIGHT-OF-WAY
CLOSURE I
AREA
Sidewalk 48 Hrs + ! q_ LF X LF
Alley 72 Hrs + I LF X LF
Parking 72 Hrs + - LF T X LF
TOTAL DURATION
(NUMBER OF MONTHS)
��- SF
SF
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.
Lestoration is to be in accordance with City codes and Standards. All street -cut trench work shall be
tched with asphalt or City approved material prior to the end of the workday — NO EXCEPTIONS.
lemnity: The Applicant has signed an application which states he/she hold the City of
Imonds harmless from injuries, damages or claims of any kind or description
iatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or
y of its departments or employees, including defense costs and attorney fees by reason
granting this permit
have read the above state nts erstand the permit requirements and acknowledge that I must
7ollow all requirement n r r t permit to be valid.
SIGNATURE DATE O 1- 30. 206'
C tractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE