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ENG2022-0347 ROW PERMITOF WAY MINOR PERMIT PERMIT NUMBER City of Edmonds EdmondsRIGHT 98020 1 1 www.cityofedmonds.gov Description: SORUM - NEW DRIVEWAY WITH ASPHALT CUTS AND TRAFFIC CONTROL ISSUED: 08/04/2022 Address: 520 OLYMPIC AVE EDMONDS WA 98020-2996 EXPIRES: 01/31/2023 Permit Type: RIGHTOF WAY MINOR Permit Subtype: RESIDENTIAL Parcel Number: 00548900002402 NAME TYPE NAME ADDRESS PHONE APPLICANT SETH CHURCH 21713 48TH AVENUE W., MOUNTLAKE TERRACE WA 98043 (425)418-7770 CONTACT ALL PHASE CONCRETE CONST 21713 48TH AVENUE W., MOUNTLAKE TERRACE WA 98043 (425)418-7770 CONTRACTOR ALL PHASE CONCRETE 21713 48th AVE W, MOUNTLAKE TERRACE WA 98043- (425)418-7770 CONSTRUCTION OWNER DIANE W SORUM 520 OLYMPIC AVE, EDMONDS WA 98020 FEE INFORMATION DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $40.00 RIGHT OF WAY MINOR PERMIT FEE $110.00 $110.00 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. BY THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW 08/04/2022 DATE Printed: Thursday, August 04, 2022 10:40:43 AM 1 of 2 WAY MINOR .UM PERMIT PERMIT NUMBER City of • • • •:• •ENG2022-0347 www.cityofedmonds. ov/425.771.0220 CONDITIONS CONDITION TYPE 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. 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 7:00am to 6:00pm on SOUND AND NOISE weekdays and 10:00am and 6:00pm 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. TRAFFIC CONTROLS Traffic Control per approved plan and MUTCD. All Flaggers shall be certified. 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 X-2 ENGINEERING FINAL" E-5 DRIVEWAY SLOPE Printed: Thursday, August 04, 2022 10:40:43 AM 2 of 2 RECEIVED cl� pf €fyAt���r ANC, 1840 SECTION A RIGHT OF WAY CONSTRUCTION PERMIT APPLICATION Complete and submit this Application in accordance with the Submittal Requirements outlined in Right -of -Way permit Handout E63. J U N 30 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. YroyectName Sorum Driveway Site Address or if no site address use Property Address at NW corner of project area: 520 Olympic Ave_ Edmonds WA Associated Permits: I BLD N/A PLN N/A I ENG N/A Name of Company N/A Franchise Ordinance No: NIA Point of Contact NIA title Address city State Zip NIJA Phone N/A Email N/A Milo NameofcompanyAll Phase Concrete Construction PrimazyName Seth Church Agent Name Seth Church Title Owner Title Owner Mobile 425-418-7770 Address 21713 48th Ave W Email City Mountlake T racel State WA Zip g$036 Seconds a0.com Phone425-776-1138 Title Email sechur4 aol.com Mobile 06-850-3846 City of Edmonds Business License No: 600607106-001-0001 Email info@allphaseconcrete.net State License No: 600607106-001-0001 9 Contractor verifies it is currently bonded f47 Contractor verifies it currently has general liability insurance NUI E: ECPC 18.60.020 requires that the Application be signed by a licensed and bonded contractor unless otherwise approved by the city engineer. ❑ Multifamily residential ❑ Commercial ❑ City project x Single family residential subdivision ❑ Single family -other o Industrial a Demo and rebuild or from vacant land? ❑ Other, please specify: ❑ Utility Franchise Work associated with development (check one of the above boxes as well) o Traffic Control Only (no associated development) City of Edmonds ROW construction permit Application --Page i of 3 Updated 3/25/2021 ❑ Utility Franchise Work (no associated development) 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 underground utilities, etc.) pour pour ew Klsting Ifor RIGHT-OF-WAY AREA TOTAL DURATION CLOSURE (Number of Months) Sidewalk 72 hours + NIA LF x NIA LF N/A SF N/A Alley 72 hours + N/A LF x N/A LF N/A SF N/A Parking 72 hours + N/A LF x N/A LF N/A SF N/A SECTION B - If you are not a utility company performing work in the City ROW, skip to SECTIQN C. 1. The work in the right of way is on or for the following type of facilities: ❑ telecommunications ❑ cable ❑ power ❑ gas ❑ water ❑ sewer ❑ storm utili owner have existin overhead infrastructure in the area of work? a ui ment be added under round or above round (e.. edestals vaults etc.)? 7proposed scribe: work connect a lot or commercial development with utilities that serve more than one lot or commercial development? q4, 4. Does the work involve rebuilding or relocating an existing aboveground utility system which connects a lot or commercial development to an existing under ound common utility system? 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? b.=yourprojective rebuilding or replacingutility equipment which currently serves more rcial development? City of Edmonds ROW construction permit Application --Page 2 of 3 Updated 3/25/2o21 If yes, answer the following questions related to project area, i.e. the actual area in which the ro'ect is proposed; 6a. Does your project involve wires/cables/lines? If yes: How many are existing? How many are to be added? 6b.1 Does your project involve poles? If yes; How many poles are existing in the prcject area? What is the height of the existing poles? How many poles are to be removed?g Are additional poles to be laced? M + - y How many? What is the height of the additionalpoles? r 6c. Are any poles to be modified/rebuilt/replaced? If yes: How man ? I I What is the height of the poles after? Describe the modification rebuild: : Q±; _ SEUF10N C Traffic Control and Public Safety. Traffic control and public safety shall be in accordance with City regul ions as required by the City Engineer. Every flagger must be trained as required by WAC 296-155-3o5 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 p alty of perjury under the laws of the State of Washington that: I am a licensed and bonded contractor; the informa provided herein is correct and complete; and I am authorized by owner to act on its behalf and have authority bind the Ter to this application. Fees. The Applicant is responsible for all it fees. /J_ APPLICANT SIGNATURE: APPLICANT PRINTED NAME: Seth Church APPLICANT TITLE: Contractor - All PhaF-,e-Co—nc-r-e-te-tonstruc—tion NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 IF NEW DRIVEWAY EXCEEDS 2000SF THAN STORMWATER , MITIGATION SHALL BE REQUIRED. FINAL MEASUREMENT '.,� 't'!. l� r ws • ` &. SHALL BE TAKEN AT FINAL. �r•:� •fob PP • •'M� (r �C�(°11J�"t Aj IN1.t'r 1 • ii' . • • 1 od u•'! a 3 • • �R'f �1 �'• a o � � ands ►�� � car ;����y r a a /Q t tw.pp ' Li- ag 7fvr' a• � l n A da*qavti • it Q • ' ' ` • J I • I W CiC i ' + • • �eQa�C, y S © rum- _ 3-7 RECEIVED JUN 30 2022 CITY OF EDMONDS M BuildingPermit.com CITY OF EDMONDS DEVELOPMENT Right -of -Way Application #1165307 - Sorum - Driveway SERVICES DEPARTMENT Applicant First Name Last Name Company Name Seth Church ALL PHASE CONCRETE CONST Number Street Apartment or Suite Number E-mail Address 21713 48th Avenue W. info@allphaseconcrete.net City State Zip Phone Number Extension Mountlake Terrace WA 98043 (425) 418-7770 Contractor Company Name ALL PHASE CONCRETE CONST Number Street Apartment or Suite Number 21713 48TH AVE W City State Zip Phone Number Extension MOUNTLAKE WA 98043 (425)418-7770 (425)776-1138 State License Number License Expiration Date UBI # E-mail Address ALLPHPC921 RP 3/20/2023 RDDisD71 Dis info@allphaseconcrete.net Project Location Number Street Floor Number Suite or Room Number 520 OLYMPIC AVE City Zip Code County Parcel Number EDMONDS 98020 00548900002402 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 Diane W Sorum Number Street Apartment or Suite Number 520 OLYMPIC AVE City State Zip EDMONDS WA 98020 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: 6/29/2022 Submitted By: Seth Church Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Right -of -Way Application #1165307 - Sorum - Driveway Project Contact Company Name: ALL PHASE CONCRETE CONST Name: Seth Church Email: info@allphaseconcrete.net Address: 21713 48th Avenue W. Phone #: (425) 418-7770 Mountlake Terrace WA 98043 Project Type Activity Type Scope of Work Single Family Residential Modification Driveway Modifications Project Sorum - Driveway Name: Excavate and haul away existing concrete driveway and carport slab total of 2300 square feet. Grade, form and pour new concrete driveway total of 1920 square feet. Grade new subgrade with crush rock and compact. Form and pour a new concrete driveway total of 1920 square feet. Description All new concrete to have #4 rebar reinforcement throughout. New concrete to have proper space of Work: control joints no further apart than 12', all new surface to be sloped to planting beds. Existing asphalt city sidewalk to be saw cut wherever new concrete meets. No street closure or sidewalk closure needed for this project. Total right away coverage for driveway approach 190 square feet. Work to be completed before September 15, 2022. Project Details Impervious Surface Adding/Replacing less than 2,000 square feet of hard surface Page 2 of 2