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ENG2022-0494 ROW PERMITRIGHT OF WAY EUC PERMIT PERMIT NUM City of Edmonds 121 Sth Ave N, Edmonds 98020 0�]ER www.edmondswa.gov425.771.0220 I�+a 1g90 Description: COMCAST-BORE SERVICE FROM PIED ACROSS STREET TO PROPERTY ISSUED: 11/07/2022 Address: 561 12TH AVE N EDMONDS WA 98020-2932 EXPIRES: 05/07/2023 Permit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00548900003102 CONTACTS NAME TYPE NAME ADDRESS PHONE APPLICANT VINICIUS FREITAS 11335 NE 122ND WAY 105, KIRKLAND WA 98034 (425)949-9293 CONTACT INFRAWEST INC 11335 NE 122ND WAY 105, KIRKLAND WA 98034 (425)949-9293 CONTRACTOR INFRAWEST INC 11335 NE 122ND WAY 105, KIRKLAND WA 98034 (425)949-9293 OWNER ROBERT KOO 561 12TH AVE N, EDMONDS WA 98020 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. 777 INSPECTION SCHEDULING: WWW.MYBUILDING PERMIT.COM 24 HR NOTICE REQUIRED OF INDEMNI�� 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. RELEASED BY: MAJ DATE: 11/07/2022 Printed: Monday, November 07, 2022 2:10:19 PM 1 of 2 RIGHT OF PERMIT ■ City of Edmonds o 121 Edmonds 98020 1 1� •� ..4& the 1 g90 www.edmondswa.gov425.771.0220 CONDITIONS TYPE RMCONDITION 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 COMPLETE A-1 JOB START X-2 ENGINEERING FINAL" E-7 RESTOR LIMITS Printed: Monday, November 07, 2022 2:10:19 PM 2 of 2 RECEIVED OCT 06 2022 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT L~�{ of EDAtO�O� RIGHT OF WAY CONSTRUCTION PERMIT APPLICATION Complete and submit this Application in accordance with the Submittal 'NC. ""o Requirements outlined in Right -of -Way permit Handout E6s. 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 Info Project Name 707223 - 561 12TH AVE N Site Address or if no site address use Property Address at NW corner of project area: 561 12TH AVE N Associated Permits: I BLD PLN ENG Owner and Entity Franchise (if pp Name of Company Holding COMCAST Franchise Ordinance No: Point of Contact JESSAMIN SANTOS Title COORDINATOR 2 Address 410 VALLEYAVE City PUYALLUP State WA Zip 98371 Phone 206401-2188 Email JESSAMIN SANTOS@CABLE.COMCAST and Authorized Agent of Owner (see note below) Name of Company INFRAWEST INC DuringContractor Contractor Contacts Primary Name VINICIUS FREITAS Agent Name VINICIUS FREITAS Title 15fle Mobile (425) 949-9293 Address 11335 NE 122ND WAY ste 105 Email VINNY.FREITAS@INFRAWEST.NET City KIRKLAND State WA Zip 98034 Secondary Name Phone (425)949-9293 Title Email VINNY.FREITAS@INFRAWEST.NET Mobile City of Edmonds Business License No: Email State License No: INFRAI-793NP ® Contractor verifies it is currently bonded ® Contractor verifies it currently has general liability insurance NOTE: ECDC 18.6o.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 ❑ Single family residential subdivision ❑ Single family -other ❑ Industrial ❑ Demo and rebuild or from vacant land? ❑ Other, please specify: ❑ Utility Franchise Work associated with development (check one of the above boxes as we10 ❑ Traffic Control Only (no associated development) N Utility Franchise Work (no associated development) City of Edmonds ROW construction permit Application --Page 1 of 3 Updated 3/25/2021 Project Description 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.) WILL BE DIRECTIONAL DRILLING 2" COMCAST SERVICE CONDUIT FROM THE COMCAST COMCAST PED TO THE ROAD (12TH AVE N). BORE 33' UNDER THE ROAD (12TH AVE N), BORE 30' OF SOFT SURFACE FROM THE ROAD (12TH AVE N) TO WHERE THE NEW COMCAST HANDHOLE WILL BE INSTALLED. HAND HOLE MEASURING 11 INCHES IN DIAMETER AND 12 INCHES DEEP. FROM THE COMCAST HANDHOLE WILL CONTINUE TO BORE IN PRIVATE PROPERTY TO THE SOUTH WAi,L OF HOUSE 561 12TH AVE N_ WILL BORE WiTH A DIRECTIONAL DRii.i. AT A MiNiMiiM DEPTH SERAKATION BETWEEN ALL UTILITIES- ALL DISTUR-RUD AREAS WILL BE RESTORED TO ORIGIN A I OR BETTER CONDITIONS RIGHT-OF-WAY CLOSURE AREA TOTAL DURATION (Number of Months) Sidewalk 72 hours + LF x LF SF Alley 72 hours + LF x LF SF Parking 72 hours + LF x LF SF SECTION B - If you are not a utility company performing work in the City ROW, skip to SECTIONC. . The work in the right of way is on or for the following type of facilities: * telecommunications x cable ❑ power ❑ gas ❑ water ❑ sewer ❑ storm Details of Work to be Completed 1. 1 Does the utility owner have existing overhead infrastructure in the area of work? Yes —No x 2. 1 Will any equipment be added underground or above ground (e.. pedestals, vaults etc.)? x 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? x If yes, answer the following questions related to project area, i.e. the actual area in which the project is proposed: 6a. Does your project involve wires/cables/lines? If yes: x How many are existing? 1 How many are to be added? 1 City of Edmonds ROW construction permit Application --Page 2 of 3 Updated 3/25/2021 6b. I Does your project involve poles? If yes: x How many poles are existing in the project area? 1 What is the height of the existing poles? 35' How many poles are to be removed? 0 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 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 fe55. APPLICANT SIGNATURE: Z� DATE: 10/03/2022 APPLICANT PRINTED NAME: VINICIUS FREITAS APPLICANT TITLE: Ik![01kWO MM:rA003xe)1e19RIs);7ICU9:4:7u1Y11f-Ris M Is)6 City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 RECEIVED OCT 06 2022 CITY OF EDMONDS EXISTING UTILITIES PLAN PAGE 2 OF 2 SERVICESLOPMENT DEPARTMENT SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY UTILITIES MAY REQUIRE A SEPERATE PERMIT. OWNER/CONTRACTOR IS RESPONSIBLE FOR EROSION CONTROL AND DRAINAGE 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. 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. ENGINEERING DIVISION APPROVED AS NOTED RECEIVED OCT 06 2022 CITY OF EDMONDS DEVELOPMENT SITE PLAN 707223 - 561 12TH AVE N, EDMONDS SERVICES DEPARTMENT WILL BE DIRECTIONAL DRILLING 2" COMCAST SERVICE CONDUIT FROM THE COMCAST PEDESTAL LOCATED BETWEEN LOTS 520 AND 540, BORE 5' OF SOFT SURFACE FROM THE COMCAST PED TO THE ROAD (12TH AVE N). BORE 33' UNDER THE ROAD (12TH AVE N), BORE 30' OF SOFT SURFACE FROM THE ROAD (12TH AVE N) TO WHERE THE NEW COMCAST HANDHOLE WILL BE INSTALLED. HAND HOLE MEASURING 11 INCHES IN DIAMETER AND 12 INCHES DEEP. FROM THE COMCAST HANDHOLE WILL CONTINUE TO BORE IN PRIVATE PROPERTY TO THE SOUTH WALL OF HOUSE 561 12TH AVE N. WILL BORE WITH A DIRECTIONAL DRILL AT A MINIMUM DEPTH OF 36 INCHES. WILL MAINTAIN A MINIMUM OF 5 FEET HORIZONTAL AND 12 INCHES VERTICAL SEPARATION BETWEEN ALL UTILITIES. ALL DISTURBED AREAS WILL BE RESTORED TO ORIGINAL OR BETTER CONDITIONS. PAGE 1 OF 2 .:.PECTMA COMCAST Figure 6H-11. Lane Closure on Two -Lane Road with Low Traffic Volumes OV3Hd5MOMtOV08 �T C 1 ' T B Otl3Htl — OvO8 3Ntl13NO ■ O (optional) (See Section 3B.16) (optional) A80M OdO8 T ON3 RECEIVED OCT 06 2022 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT ENGINEERING DIVISION APPROVED AS NOTED ORM 7 M IN DE hE END i ROAD WORK (optional) 30 m (100 ft) MAX. Buffer Space (optional) Buffer + pace (optional) YIELD 30 m (100 ft) MAX. i =4.6m(15ft) TO ONCOMING A � TRAFFIC 1v B i ONE LANE 1 ROAD AHEAD willo 1 ROAD WORK AHEAD RECEIVED OCT 06 2022 CITY OF EDMONDS MyBuildingPermitxom CITY OF EDMONDS Right -of -Way Application #1210756 - 707223 - 561 12TH AVE N DEVELOPMENT �� SERVICES DEPARTMENT Applicant First Name Last Name Company Name VINICIUS FREITAS INFRAWEST INC Number Street Apartment or Suite Number E-mail Address 11335 NE 122ND WAY 105 vinny.freitas@infrawest.net City State Zip Phone Number Extension KIRKLAND WA 98034 (425) 949-9293 Contractor Company Name INFRAWEST INC Number Street Apartment or Suite Number 11335 NE 122ND WAY 105 City State Zip Phone Number Extension KIRKLAND WA 98034 (954)756-0230 State License Number License Expiration Date UBI # E-mail Address INFRAI*793NP 7/23/2023 RD477f115g vinny.freitas@infrawest.net Project Location Number Street Floor Number Suite or Room Number 561 12TH AVE N City Zip Code County Parcel Number EDMONDS 98020 00548900003102 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 Robert Koo Number Street Apartment or Suite Number 561 12TH AVE N 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: 10/3/2022 Submitted By: VINICIUS FREITAS Page 1 of 2 i CITY OF EDMONDS My6uildingPermit.com Right -of -Way Application #1210756 - 707223 - 561 12TH AVE N Project Contact Company Name: INFRAWEST INC Name: VINICIUS FREITAS Email: vinny.freitas@infrawest.net Address: 11335 NE 122ND WAY 105 Phone #: (425) 949-9293 KIRKLAND WA 98034 Project Type Activity Type Scope of Work Utility Purveyor Utility Work Disturbance of Surface Project 707223 - 561 12TH AVE N Name: WILL BE DIRECTIONAL DRILLING 21NC COMCAST SERVICE CONDUIT FROM THE COMCAST PEDESTAL LOCATED BETWEEN LOTS 520 AND 540, BORE 5FT OF SOFT SURFACE FROM THE COMCAST PED TO THE ROAD (12TH AVE N). BORE 33FT UNDER THE ROAD (12TH AVE N), BORE 30FT OF SOFT SURFACE FROM THE ROAD (12TH AVE N) Description TO WHERE THE NEW COMCAST HANDHOLE WILL BE INSTALLED. HAND HOLE of Work: MEASURING 11 INCHES IN DIAMETER AND 12 INCHES DEEP. FROM THE COMCAST HANDHOLE WILL CONTINUE TO BORE IN PRIVATE PROPERTY TO THE SOUTH WALL OF HOUSE 561 12TH AVE N. WILL BORE WITH A DIRECTIONAL DRILL AT A MINIMUM DEPTH OF 36 INCHES. WILL MAINTAIN A MINIMUM OF 5 FEET HORIZONTAL AND 12 INCHES VERTICAL SEPARATION BETWEEN ALL UTILITIES. ALL DISTURBED AREAS WILL BE RESTORED TO ORIGINAL OR BETTER CONDITIONS. Project Details Project Information Job Number 707223 Page 2 of 2