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ENG2022-0385 ROW PERMITOF WAY EUC PERMIT o PERMIT NU M City of Edmonds EdmondsRIGHT 98020 1 1 WWW.Cityofedmonds.govi Description: PSE-RESTORATION ONLY FOR EMERGENCY WORK ISSUED: 08/22/2022 Address: 8610 191ST PL SW EDMONDS WA 98026-5940 EXPIRES:02/22/2023 Permit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00672700000700 CONTACTS 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)516-4388 OWNER BLAIR ALEXANDER 8610 191ST PL SW, EDMONDS WA 98026 FEE INFORMATION DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $40.00 ENGINEERING INSPECTION FEE $110.00 $110.00 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. 7- INSPECTION SCHEDULING: WWW.MYBUILDING PERMIT.COM 24 HR NOTICE REQUIRED r 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 08/22/2022 RELEASED BY DATE Printed: Monday, August 22, 2022 8:02:26 AM 1 of 2 oe e n,y RIGHT OF WAY EUC PERMIT PERMIT NU�M City of Edmonds EdmondsAd 98020ENG2022-031 www.cityofedmonds.gov / i CONDITIONS CONDITION TYPE NOTES 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 7:00am 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. 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 NOTES COMPLETE A-1 JOB START X-2 ENGINEERING FINAL" E-7 RESTOR LIMITS Printed: Monday, August 22, 2022 8:02:26 AM 2 of 2 of EpMO� RECEIVED �`� RIGHT OF WAY CONSTRUCTION J U L 20 2022 PERMIT APPLICATION CITY OF EDMONDS Complete and submit this Application in accordance with the Submittal DEVELOPMENT /'Vc. is') Requirements outlined in Right -of -Way permit Handout E6�. 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. SECTION A General • Project Name 109143527 Site Address or if no site address use Property Address at NW corner of project area: 8610 191st PL SW 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? ixOther, please specify: Restoration only ❑ 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 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: 07/18/22 APPLICANT PRINTED NAME: Susan Sidick 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 PRE -INSPECTION REPORT Job #: 109143527 Date Received: Jurisdiction: Snohomish Right of Way Permit? ❑✓ YES First Poss Start: First Poss Comp: Address: 8610 191st PL 5W City / Zip: Edmonds ❑ No Cust Name: 15D 15D Customer Email: PM / Insp: Project Managers ® PUGET SOUND ENERGY Job Description / Scope of Work: Est. Job Duration: NEW CONST.- ❑ YES ❑ NO Vac around sewer pipe to make sure we have seperation from gas main IFS / PSE Dig Service Work - No Stub Ftg: Ext Ftg: I Tot Svc Ftg: 0' Main Ext Work - No PLAT MAP# FIELD INSPECT—M.I.W.ON: BY: t wIII Utility patches shall be combined and full width or half RECEIV width overlay will be required depending on the extent of disturbance. Where utility patches fall entirely within JUL 20 2j 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. CITY OF EDMO DEVELOPME { > SERVICES DEPA _ 17— - SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT COM IL_ �. 1 co_IL 191st PL SW 1111105 - -- - - - WTRSVCIMAIN---------------- - - - - -- SANSEWER------------------- _ I 2" PE IP 48' R - - 941 0634 ----------------- ` U -i �_�-) �I� � � T -1 - v - , � OWNER/CONTRACTOR IS RESPONSIBLE FOR i 1 EROSION CONTROL AND DRAINAGE ® ENGINEERING DIVISION I Applicant shall repair/replace all 1 APPROVED AS NOTED ; damage to utilities or frontage - improvements in City right-of-way per city standards that is caused or 08/11/2022 occurs during the permitted project.vv --I Work Location Size of Cut Surface Ty e 48' R of CL 191st PL SW & 549' E of CL 88Th Ave W 3X5 Asphalt of CL & of CL of CL & of CL ❑ FLAGGERS #: MPH ❑ TROLLEY LINES ❑ BUS STOP #: ❑ METER HOODS M ❑ OFFICERS M SPEED LIMIT ❑ TRAFFIC ❑ ARTERIAL ❑ NO PARKS #: WORK TYPES Pipe Size EFV'S Meters Qty. Pressure Misc Meter Stuff ❑POTHOLE ❑ COMMERCIAL ❑STUB ❑ 1/2" ❑ 775 ❑ 5/8 ❑ 250 ❑ 6"wc ❑ Tempi Bar Size: ❑ RESIDENTIAL ❑ EXTENSION ❑MAIN MAINT. ❑ COMPLETE ❑ 1800 ❑ 3/4" ❑ 11/8" ❑ 2600 — ❑ 425 ❑ 2# ❑ Bollards 2.5" #: ❑SERV MAINT. ❑ MULTI -FAMILY El TWIN ❑ 11/4" ❑ 10,00 _ > ❑ 630 5# ❑ ❑ Bollards 4" #: ❑ NEW CONST. ❑ ALTER COMM SVC ❑VALVE MAINT. ❑ 2" ❑ N/A ❑4 _ _ Fuel Line Permit ❑ ❑ ALTER RESID. SVC ❑LEAK REPAIR ❑ 6" ❑ 1000 Fuel Line Length: ❑ CUT & CAP ❑ SERVICE REPL. ❑CP WORK ❑ 8" Mtr Loc: Fuel Line Diameter: ED 122 JDS IT WENT Notes: 1. All signs and spacing to conform to the MUTCD and City of Edmonds 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 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 549' ECL of 88th Ave W & 48' R of 191 st PI SW. 9. If used, place NO -PARK signs 72 hours in advance of the day that the work is to be done. LEGEND ® 28" TRAFFIC CONE ® WORK PIT TRAFFIC FLOW WORK VEHICLE/ FLASHING LIGHTS SIGN LOCATION RIGHT OF WAY R0W TEMPORARY TRAFFIC CONTROL PLAN SIGN SPACING MPH nx" 60/65 1000, 45/55 500' / 35/4 0EE 50' 3100, 0' 25 CHANNELIZATION DEVICE SPACING MPH TAPER TANGENT 55/70 40 80 35/45 30 60 25/30 20 40 ZZOZ/ t t /80 �1�rn SOUND ENERGY Saaa�lA Nllma 3 (425) 398-6077 safaa.alneema@pse.com Project Address: 8610 191 st PI SW, Edmonds, WA 98026 RESIDENT(S) WILL BE INFORMED OF TEMPORARY DRIVEWAY CLOSURE EMERGENCY VEHICLES WILL BE ALLOWED TO PASS WORK ZONE. 8610 191 st PI SW Edmonds WA 98026 USA RECEIVED JUL 20 2022 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT Puget Sound Energy REV Traffic Control Supervisor: Safaa o..Neema 07/15/2022 0 Card No. 012611 Card Exp. 10/31/2024 Job # Safaa.alneema@pse.com "25'398 °77 ',� 109143527 1 OF 1 RECEIVED CITY OF EDMONDS Right -of -Way Application #1174350 - 109143527 J U L 20 2022 MyBuildingPernrriit.corn CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT Applicant First Name Last Name Company Name Susan Sidick Puget Sound Energy- Corrosion Department Number Street Apartment or Suite Number E-mail Address 1660 Park Lane susan.sidick@pse.com City State Zip Phone Number Extension Burlington WA 98233 (425) 457-6353 Contractor Company Name PUGET SOUND ENERGY INC Number Street Apartment or Suite Number 1660 Park Lane City State Zip Phone Number Extension Burlington WA 98299 (206) 716-2641 State License Number License Expiration Date UBI # E-mail Address PUGETSE032J 1 3/20/2024 179n 1 M55 susan.sidick@pse.com Project Location Number Street Floor Number Suite or Room Number 8610 191 ST PL SW City Zip Code County Parcel Number EDMONDS 98026 00672700000700 Associated Building Permit Number Tenant Name 109143527 Additional Information (i.e. equipment location or special instructions)_ Work Location Property Owner First Name Last Name or Company Name Blair Alexander Number Street Apartment or Suite Number 8610 191 ST PL SW City State Zip EDMONDS WA 98026 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: 7/18/2022 Submitted By: Susan Sidick Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Right -of -Way Application #1174350 - 109143527 Project Contact Company Name: Puget Sound Energy- Corrosion Department Name: Susan Sidick Email: susan.sidick@pse.com Address: 1660 Park Lane Phone #: (425) 457-6353 Burlington WA 98233 Project Type Activity Type Scope of Work Utility Purveyor Utility Work Disturbance of Surface Project Name: 109143527 Description of permit requested for restoration only Emergency vacuum around sewer pipe for seperation Work: repair follow up work area is approx 48' R 191 st PL SW & 549' E c/I of88th AVE W (1) 3x5 paving cut anticipated Project Details Project Information Job Number 109143527 Page 2 of 2