ENG ROW PERMITOF WAY PERMIT
PERMIT ER
City •EdmondsRIGHT
121 Sth Ave N, Edmonds WA 98020 ENG2022-0529
www.edmondswa.gov i
Description: ROW - PARKING ONLY FOR FOUNDATION REPAIR ON PRIVATE PROPERTY
ISSUED: 11/10/2022
Address: 133 SUNSET AVE N EDMONDS WA 98020-4134
EXPIRES: 11/05/2023
Permit Type: RIGHT OF WAY Permit Subtype: RESIDENTIAL Parcel Number: 00434401300500
NAME TYPE NAME ADDRESS PHONE
APPLICANT DANIEL ELLIS 133 SUNSET AVE N, EDMONDS WA 98020 (425)361-6655
CONTACT DANIEL ELLIS 133 SUNSET AVE N, EDMONDS WA 98020 (425)361-6655
CONTRACTOR ADVANCED FNDTN SUPPORTS LLC 22102 SPRUCE DRIVE, MONROE WA 98272 (206)852-2450
OWNER MAY ANN STARK 133 SUNSET AVE, EDMONDS WA 98026
FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE CHARGED PER PERMIT
$40.00 $40.00
RIGHT OF WAY STANDARD 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.
INSPECTION SCHEDULING: WWW.MYBUILDING PERMIT.COM
24 HR NOTICE REQUIRED
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: WHJ DATE: 11/10/2022
Printed: Thursday, November 10, 2022 10:31:14 AM 1 of 2
RIGHT OF WAY PERMIT
PERMIT NQ �!BEJ
City of Edmonds
SID
www.edmondswa.gov • •
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.
FINAL INSPECTION
The engineering division requires 48 hours notice prior to the date of the FINAL Inspection.
SCHEDULING
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:OOam to 6:OOpm on
SOUND AND NOISE
weekdays and 10:OOam and 6:OOpm 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.
• •
INSPECTION TYPE
DATE
RESULT
NOTES
IR
COMPLETE
X-2 ENGINEERING FINAL**
A-1 JOB START
E-7 TRAFFIC CTRL
Printed: Thursday, November 10, 2022 10:31:14 AM 2 of 2
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SECTION A
RIGHT OF WAY CONSTRUCTION
PERMIT APPLICATION
RECEIVED
OCT 27 2022
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
Complete and submit this Application in accordance with the Submittal
Requirements outlined in Right -of -Way permit Handout E6S.
If any Meld is not applicable to your project, Write "N/A" instead of leaving blank.
All fields required. Incomplete Applications will be denied.
Owner and Entity
Holding Franchise (if applicable)
Name of Company
Franchise Ordinance No:
Point of Contact
Ah
Title
Address 133
S V J
City ee3o
State W A Zip g 02, CO
Phone 2. :3 - (a a 5 5"
Email
11 i
905 0 dL/y 'kL G
Contractor and Authorized Agent of Owner
Name of Company
A � V
(see note below)
-{ r,
:
Contractor Contacts During Constmetion
Primary Name
t o w�•l' C l t r k
Agent Name l�0 4 rj C a r K
'Title &,ek%trcJ eL*4 a ,
Mobile L _ c�, -z _ Z L d
Title � r� a^
v%
Address 2 2 0 Z S vVLe_ Dr
Email 140a(a -Fogy o ej.o&A Sv of S, Coi"I
City kO A) R CAE
State Li
Zip 1 9--Z7L
Secondary Name H ,
Phone S Z— Z 5-5
Title p �C r-� �✓ ►motr- .
Email W �AO< '
Mobile
qZ.— 3 6) - 6 6 S
City of Edmonds Business License No: b 0 Zqq (0185-- 0011 �- 0002
Email e (l 1 S U 8 0� C 9 votz-d
L o ✓''1
State License No: ADVAMFS iOS -0
Contractor verifies it is currently bonded
Contractor verifies it currently has general liability insurance
NOTE: ECDC 18.6o.02o requires that the Application be signed by a licensed and bonaea conrracror uncess ornerwise approvea oy me ciry
engineer.
❑ Multifamily residential
❑ Single family residential subdivision
❑ Demo and rebuild or from vacant land?
❑ Commercial
j4 Single family -other
❑ City project
❑ Industrial
❑ Other, please specify:
❑ Utility Franchise Work associated with development (check one of the above boxes as well)
❑ Traffic Control Only (no associated development)
City of Edmonds ROW construction permit Application --Page 1 of 3 Updated 3/25/2021
IltilitN- I,r:mchise Wol'l: (110 asSociate(I cl(w(`loprncnt)
IlIcIll(io an merall n;ll•ratiVO llescriptio)ll of Illo` p1.o)p()s(1ci \,vo)rl(, Be specific alicl (letailed:
Describe illfl'astl•lll•tllre to 1w illlll;il'tl`ll, slll'll as, poles, Wires,l'OIl(11111, Iltlllty 111"11115, CLC.
Include \N'lletller till` is collstnictio)►l, illalIll (`11;111('(`, or I't`l)all'.
l ncl ide description of' propose(I colist rtlet ion Illet 11mis, (e.g., N)I-es, I reliclies, Overhead wires proposed, depth for
lllldl`lgrollll(i lltilifies, vte.)
Cali
b 0\11 d 1,\V�
L, 0 20zz- C 1Y &
RIGHT-OF-WAY
CLOSURE
��IZF.��
T011AL
DURATION
(Number of Months)
Side\,\-alk 72 hours +
LF
x
LF
SF
i .klle\- -2 hours +
LF
x
LF
SF
r 4
Parkin 72 hours +
63.5 LF
x
8 LF
508 SF
< 1 month
SECTION B - If you are not a utility company performing work in the City ROW, skip to SECTION C.
�. The work in the right of way is on or for the following type of facilities:
telecommunications ❑ cable ❑power
water
❑ sewer
❑ storm
■:.
Details of Work to be Completed
Yes
No
1. Does the utility owner have existing overhead infrastructure in the area of work?
2. Will any equipment be added underground or above ground (e.g. pedestals, vaults, etc.)?
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?
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 system?
5.
Does the work involve proposed additions to an ality 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?
6. Does your project involve rebuilding or replacing utility equipment which currently serves more
than one lot or commercial development?
City of Edmonds ROW construction permit Application --Page 2 of 3 Updated 3/25/2021
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:
How many are existing?
How many are to be added?
6b.
Does your project involve poles? If yes:
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 additionato be laced?
l oles
How man ?
—F
I What is the height of the additional oles?
76c.Are
any poles to be modified/rebuilt/replaced? If yes:
How many?
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:
APPLICANT PRINTED NAME:
APPLICANT TITLE:
we C4.,07 ov
40e\'� DATEJ - 3 V ' 2 Z.
a •4
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021