ENG2022-0528 ROW PERMIT�~ o� RIGHT OF WAY EUC PERMIT
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f
EdmondsCity of Edmonds PERMIT NU M
98020 ENG2022-025
www.edmondswa.gov i
Description: PSE - INSTALL GAS SERVICE
ISSUED: 12/01/2022
Address: 23911 107TH PL W EDMONDS WA 98020-5240
EXPIRES:06/01/2023
Permit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00689500002400
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 TRAVIS & JENNA POPE
23911 107TH PL W, 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.
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.
RELEASED BY: MAJ DATE: 12/01/2022
Printed: Thursday, December 01, 2022 10:33:07 AM 1 of 2
RIGHT PERMIT
PERMIT NUM
City of Edmonds
Edmonds WA 98020 •
www.edmondswa.gov / 425.1 1
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: Thursday, December 01, 2022 10:33:07 AM 2 of 2
RECEIVED
of EpM04O�
SECTION A
RIGHT OF WAY CONSTRUCTION
PERMIT APPLICATION
Complete and submit this Application in accordance with the Submittal
Requirements outlined in Right-of-Wgy permit Handout E6�.
Nov 01 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.
General •
Project Name 106389742
Site Address or if no site address use Property Address at NW corner of project area: 23911 107TH PL W
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 :R 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 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
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.)
Occupying the end of cul-de-sac of 107th PI W to, FROM 1-1/4" PE MAIN"`INSTALL 115' OF 1-1/8" PE ALL SCAT(80STUB/35EXT)SET A425 OR. 4 (3x5) hard surface cuts anticipated.
RIGHT-OF-WAY
CLOSURE
AREA
TOTAL
DURATION
(Number of Months)
Sidewalk 72 hours +
LF
I x
LF
SF
Alley'72 hours +
LF
Ix
I LF
SF
Parking 72 hours +
LF
Ix
I LF
SF
1
SECTION B - If you are not a utility company performing work in the City ROW, skip to SECTION 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
Details of Work to be Completed
1. Does the utility owner have existing overhead infrastructure in the area of work?
Yes
No
x
2. 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? I I How many are to be added?
City of Edmonds ROW construction permit Application --Page 2 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:
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
RECEIVED
Job #:
Date:
Jurisdiction:
ROW Permit:
Est. Start Date:
Est. Duration:
Puget Sound Energy Gas Pre -Inspect Form
106389742 Service Address: 23911 107TH PL W
9/30/22
WOODWAY
Yes
1-1/2 Days (12 hours)
City
Customer:
Customer Email:
PM / Inspector:
Site Contact Email:
EDMONDS Zip: 98020
JENNA POPE Phone:
jenna.c.murawski@gmail.com
Jeffrey Naranjo Phone- (425) 449-6423
jenna.c.murawski@gmail.com Phone: (760) 953-7686
Job Description
Project Scope: FROM 1-1/4" PE MAIN**INSTALL 115' OF 1-1/8" PE ALL SCAT(80STUB/35E; T)SET A425 OR
New Construction:
RESTORATION LIMITS TO BE DETERMINED
BY CITY ENGINEERING INSPECTOR
Construction Method
Hole Hog
Building Foundation Type
SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM
Slab
Septic System
No
PLAT Map: 162.067
ENGINEERING DIVISION
. "DTED N
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_
1 /22/2022
I 50' f0W
1-
Applicant shall repair/replace all
I
I I
damage to utilities or frontage OWNER/CONTRACTOR
improvements in City right-of-way
IS RESPONSIBLE FOR
I I
per city standards that is caused or EROSION CONTROL AND DRAINAGE
I
I
occurs during the permitted project.
OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING
N i
ALL ON SITE UTILITIES.
RELOCATION/REVISION TO ANY
j V
UTILITIES MAY REQUIRE
A SEPERATE PERMIT.
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x
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Proposed 1-1/8"SVC
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A425
I
3
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Work Location
Size of Cut
Surface Type
355'
1 South
I of CL
1237TH PL SW
&
37'
West
of CL
107TH PL W
3 X 5 X 3
A
355'
South
of CL
237TH PL SW
&
10'
West
of CL
107TH PL W
3 X 5 X 3
A
355'
Southl
of CL
1237THPLSW
&
4'
West
of CL
1107THPLW
3 X 5 X 3
A
355'
1 South
I of CL
1237TH PL SW
&
5'
1 East
of CL
1107THPLW
3 X 5 X 3
A
Service Information
Street Information
Job Type
Diameter:
1-1/8" PE
Flaggers #:
0
Arterial:
No
New Residential Svc
EFV:
1-1/8" - 2600 - 9999144
Police #:
0
TCP:
Yes
Tie -In Fitting
Meter:
A425
Speed Limit:
0
No Parks #:
0
MDPE - 1 - 1/4" IPS - (DIA) V CTS
9999546
Meter Loc:
08 - OR
Trolley Lines:
No
Mtr Hoods #:
0
Del Press:
6" W.C.
Traffic Signal:
Bus Stop:
No
SNo YRD -Snohomish
Bollards:
1 2.5" # 4" #
ADA Ramps #:1
0
Route #'s:
Nov 01 2022
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
TEMPORARY TRAFFIC CONTROL PLAN
RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
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.
0
0
0
0
iJ
14I14
237th PL SW
ENGINEERING DIVISION
.'7TED
ra
23911 107th PI W
• Edmonds
WA 98020
USA
OWNER/CONTRACTOR IS RESPONSIBLE FOR
EROSION CONTROL AND DRAINAGE
OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING
ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY
UTILITIES MAY REQUIRE A SEPERATE PERMIT.
Notes:
1. All signs and spacing to conform to the
MUTCD and WOODWAY 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 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 355' SCL of 237th PL SW & 37'
WCL of 107th PL W and 355' SCL of 237th PL SW & 10'
WCL of 107th PL W and 355' SCL of 237th PL SW & 4'
WCL of 107th PL W and 355' SCL of 237th PL SW & 5'
ECL of 107th PL W.
SIGN SPACING
MPH
"X"
60/65
1000,
45/55
500'
35/40
350'
30
200'
25
100'
1 /22/2022
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
RECEIVED
Nov 01 2022
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
LEGEND
®
28" TRAFFIC CONE
®
WORK PIT
TRAFFIC FLOW
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
ROW -
Puget Sound Energy REV
PUGET Designer: Traffe Control Supervisor:
GregorySOUND David J. Shrope Co'dNo 01223d 10/18/2022 0
Card No. 012238
ENERGY (425) 424-6425 Card ry.hamood@ps Job #
g regory, ha rwood@pse. com
david.shrope@pse.com (425)424-6425 511333313
Project Address:
23911 107th PL W, EDMONDS, WA Page 1 OF 1