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ENG2023-0069 ROW PERMIT�~ o� RIGHT OF WAY EUC PERMIT o f EdmondsCity of Edmonds PERMIT NUM 980201 11.'• www.edmondswa.gov i Description: PSE-CUT & CAP GAS SERVICE ISSUED: 03/06/2023 Address: 7416 176TH ST SW EDMONDS WA 98026-5528 EXPIRES: 09/06/2023 Permit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00513600001600 CONTACTS NAME TYPE NAME ADDRESS PHONE APPLICANT SUSAN SIDICK 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353 CONTACT PUGET SOUND ENERGY 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353 CONTRACTOR PSE/INFRASOURCE 1660 PARK LANE, BURLINGTON WA 98233 (425)516-4388 OWNER UNKNOWN UNKNOWN 7416 176TH ST SW, EDMONDS WA 98026 FEE INFORMATION DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $40.00 ENGINEERING INSPECTION FEE $220.00 $220.00 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: 03/06/2023 Printed: Monday, March 06, 2023 12:37:30 PM 1 of 2 o� e pM RIGHT PERMIT PERMIT NUM City of Edmonds Edmonds A':1 1 00•• 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 E-7 TRAFFIC CTRL X-2 ENGINEERING FINAL" E-7 RESTOR LIMITS Printed: Monday, March 06, 2023 12:37:30 PM 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�. Feb 07 2023 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 io8641833 Site Address or if no site address use Property Address at NW corner of project area: 7416176TH ST 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 ix 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.) Cut and cap gas service at approx 123' E c/l of Soundview Way & 12' S c/l of 176th ST SW (1) 3x10 paving cut anticipate RIGHT-OF-WAY CLOSURE AREA TOTAL DURATION Nm r ofMnh Sidewalk 72 hours + LF I x LF SF Alley 72 hours + LF Ix I LF SF Parking 72 hours + I LF Ix I LF I SF 1 1 SECTION B - If you are not a utility company performing work in the City ROW, skip to SECTIONC. 1. The work in the right of way is on or for the following type of facilities: ❑ telecommunications ❑ cable ❑ power d5gas ❑ 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: 02/o6/23 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 SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM Puget Sound Energy Gas Pre -Inspect Form Job #: 108641833 Service Address: 7416 176th St SW Date: 1/23/23 City Edmonds Zip: 98026 Jurisdiction: Edmonds Customer: Phone: ROW Permit: YES Customer Email: Est. Start Date: PM / Inspector: Jennifer Bergman Phone: Est. Duration: 6 Hrs Site Contact Email: Mitchell Goetz Phone: Job Description RETIRE IDLE SVC AT MAIN. EXPOSE AT PLATTED LOCATION, IF NOT FOUND PLEASE New Construction: EXCAVATE 5' ON EITHER SIDE OF PLATTED TIE IN TO VERIFY PREV. C/C. No Utility patches shall be combined and full width or half Construction Method width overlay will be required depending on the extent Open Trench of disturbance. Where utility patches fall entirely within Building Foundation Type one travel lane, the overlay shall extend to the Concrete centerline of roadway. Where utility patches extend into Septic System both travel lanes then a full width overlay is required. No PLAT Map: 159.070 176TH ST SW RESTORATION LIMITS TO BE DETERMINED CJ" N BY CITY ENGINEERING INSPECTOR r SEWER W N --—————————————————————————————————————————---—————————————— ————— i i i i ...... ...... ...... ...... ...... ...... ...... ... .—.—.—.------- .------ —'6/L i o WATER MAIN 4'S ------------------------------------------------------------------------ ------- 2" STW 12'S 226 7-1960 —----------------------------------;--------------- ------- STORM 14'S I I OP I I NR I I I I I I I I OVERHEAD PWR & COMM � I w I Z OWNER/CONTRACTOF o ; I I EROSION CONTRI Work Location Size of Cut Surface Type 123' 1 t I ofCL SOUNDVIEW WAY & 1 12' 1 S I ofCL 1176TH STSW 3 X 1OX A of CL & I of CL Service Information Street Information Job Type Diameter: 1/2" STW Flaggers #: 0 Arterial: No C&C EFV: 0 Police #: 0 TCP: No Tie -In Fitting Meter: Speed Limit: 0 No Parks #: 0 Meter Loc: 0 Trolley Lines: No Mtr Hoods #: 0 Del Press: Traffic Signal: Bus Stop: No Bollards: 2.5" # 4" # ADA Ramps #: 0 Route #'s: RECEIVED Feb 07 2023 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT IS RESPONSIBLE FOR DL AND DRAINAGE Applicant shall repair/replace all ENGINEERING DIVISION OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING damage to utilities or frontage APPROVED AS NOTED ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY improvements in City right-of-way per city standards that is caused or ,I UTILITIES MAY REQUIRE A SEPERATE PERMIT. occurs during the permitted project. hyfi ,WQ✓Jj$,,nnQ 03/02/2023 TEMPORARY TRAFFIC CONTROL PLAN GAN Hom:]Hl SNOUCIAdSNI �-iv E n(]EIHOS do l�iS SI 9NOZ >Q10M 2E]n9NAHM clai aj A9 IVHS NOIlO�IdSNI OI*NET SW 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 10' 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 Work area will be 123' ECL of Soundview Way and 12' SCL of 176th St. SW. 9. If used, place NO -PARK signs 72 hours in advance of the day that the work is to be done. RESIDENT(S) WILL BE INFORMED OF TEMPORARY DRIVEWAY CLOSURE A —_�-_�S-'% � -� _�_ � _�--_ � �--_�-�- ram- A Si' A _ � _ � • y...fy_•-•� • ` X' X, X, o f f W20-1 m W20-7A s�oP W20-4 O9 \9 PN P G -7 7416 176th St S W Edmonds LEGEND ® 28" TRAFFIC CONE WORK PIT TRAFFIC FLOW %r FLAGGER WORK VEHICLE/ FLASHING LIGHTS SIGN LOCATION RIGHT OF WAY ROW a PLACE SIGNS BOTH SIDES OF WORK AREA ®n0> SIGN SPACING MPH "X" 60/65 1000, 45/55 500' 35/40 350' 30 200' 25 100, G WA 98026 USA DEADEND Cn� \ 176TH ST. SW \ o HaOM ` X \, PLACE W20-1 SIGNS ON ALL \ ADJACENT STREETS WITHIN FEET OF WORK AREA x \ ROAD C) WORK ocli 9`9 AHEAD \ CHANNELIZATION DEVICE SPACING MPH TAPER TANGENT 55/70 40 80 35/45 30 60 25/30 20 40 USE MAXIMUM AVAILABLE SPACE FOR SIGNS £ZOZ/ZO/£077M fill, PUGET Designer: SOUND Jomo Watts ENERGY (425) 424-6658 jomo watts@pse corn Project Address: 7416 176TH ST. SW, EDMONDS, WA adlON S`d GAAO2JddV NOISIAIG JNRJ33NIJN3 J s NCB 1`Wd eYY,410`J 01 /30/2023 Card Exp. 09/30/2023 Job # £Z t'42�1 ,6d m n 11916304 REV RECEIVED CITY OF EDMONDS MyBuildingPermit.com Feb 07 2023 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT Right -of -Way Application #1264602-108641833 Applicant First Name Last Name Company Name Susan Sidick Puget Sound Energy 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 WA 98233 425-457-6353 State License Number License Expiration Date UBI # E-mail Address PUGETSE033DD 3/28/2023 17gD 1 nns.si susan.sidick@pse.com Project Location Number Street Floor Number Suite or Room Number 7416 176TH ST SW City Zip Code County Parcel Number EDMONDS 98026 00513600001600 Associated Building Permit Number Tenant Name 108641833 Additional Information (i.e. equipment location or special instructions)_ Work Location Property Owner First Name Last Name or Company Name Unknown Unknown Number Street Apartment or Suite Number 7416 176TH ST 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: 2/6/2023 Submitted By: Susan Sidick Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Right -of -Way Application #1264602-108641833 Project Contact Company Name: Puget Sound Energy Name: Susan Sidick Email: susan.sidick@pse.com Address: 1660 Park Lane Phone #: (425) 457-6353 Burlington WA 98233 Project Type Utility Purveyor Activity Type Utility Work Scope of Work Disturbance of Surface Project Name: 108641833 Description of Work: Cut and cap gas service at approx 123' E c/I of Soundview Way & 12' S c/I of 176th ST SW (1) 3x10 paving cut anticipated Project Details Project Information Job Number 108641833 Page 2 of 2