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ENG2023-0008 ROW PERMIT�~ o� RIGHT OF WAY EUC PERMIT o f City of Edmonds PERMIT NU M www.edmondswa.gov i Description: ZIPLY - RISER DOWN POLE WITH NEW UG SERVICE ISSUED: 03/13/2023 Address: 7904 234TH ST SW EDMONDS WA 98026-9305 EXPIRES: 09/13/2023 Permit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00576700002901 CONTACTS R NAME TYPE NAME ADDRESS PHONE APPLICANT CAITLI N REID 1800 41ST ST STE N-100, EVERETT WA 98203 (425)261-6488 CONTACT ZIPLY FIBER 1800 41ST ST STE N-100, EVERETT WA 98203 (425)261-6488 CONTRACTOR PACIFIC CABLE CONSTRUCTION PO BOX 573, WOOD INVILLE WA 98072 (425)346-2083 OWNER J W J\K M\GOOS TM\L D TTE PO BOX 2002, BOTHELL WA 98011 THERRELL FEE INFORMATIO 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: 03/13/2023 Printed: Monday, March 13, 2023 9:04:49 AM 1 of 2 o� e pM RIGHT PERMIT PERMIT NU�M 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 E-7 TRAFFIC CTRL X-2 ENGINEERING FINAL" Printed: Monday, March 13, 2023 9:04:49 AM 2 of 2 RECEIVED Lti�y of ED%�O� ANC. 1 g90 SECTION A RIGHT OF WAY CONSTRUCTION PERMIT APPLICATION Complete and submit this Application in accordance with the Submittal Requirements outlined in Right -of -Way permit Handout E63. JAN 06 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 Info Project Name WO# 162207 Site Address or if no site address use Property Address at NW corner of project area: 7904 Apt. A4 234th St. SW, Edmonds, WA Associated Permits: BLD PLN ENG Owner and Entity Holding Franchise (if applicable) Name of Company Ziply Fiber Northwest, LLC Franchise Ordinance No: WN U-17 Point of Contact M i ke H a ka h a n Title Engineer Addressl 800 41 st St., Ste. N 100 city Everett State WA zip 98203 Phone 425-949-0230 Email mike.hakahan@ziply.com AuthorizedContractor and Agent of •wner (see note belo NameofCompany Pacific Cable Construction Primary Name Danielle Herrera Agent Name Danielle Herrera Title Permit Manager Title Permit Manager Mobile 425-348-7735 AddressPO Box 573 Email danielle@paccab.com city Woodinville State WA zip 98072 Secondary Name Phone 425-348-7735 Title Email danielle@paccab.com Mobile City of Edmonds Business License No: PACI FCC954PJ Email State License No: 3636CON 1096 E3 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 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 well) vi Traffic Control Only (no associated development) City of Edmonds ROW construction permit Application --Page 1 of 3 Updated 3/25/2021 ❑ Utility Franchise Work (no associated development) 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.) Telecommunications and broadband provider Ziply Fiber to axcess the pole and put in a riser down and continue to the customer. RIGHT-OF-WAY CLOSURE AREA TOTAL DURATION (Number of Months) Sidewalk 72 hours + LF JxJ LF SF Alley 72 hours + LF JxJ F SF Parking 72 hours + LF JxJ LF SF 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 1. CompletedDetails of Work to be Does the utility owner have existin overhead infrastructure in the area of work? V • 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 aboveground utility system? If es: V Are the additions for the purpose of serving new commercial development? Are the additions for the purpose of serving a single-family residential subdivision? Details of • to be Completed ®i 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? 11 1 How many are to be added? 1 6b. Does your project involve poles? If yes: How many poles are existing in the project area? 1 What is the height of the existing poles? 40' How many poles are to be removed? 0 Are additional poles to be laced? None How many? I I What is the height of the additionalpoles? 6c. Are any poles to be modified/rebuilt/replaced? If yes: 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: Z�)"AZ � APPLICANT PRINTED NAME: Derrick Kasuske APPLICANT TITLE: Permit Coordinator/ TCP NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE 1 /5/2023 City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 LEGEND: SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM [ EXISTING TERMINAL FTMI PROPOSED TERMINAL ® EXISTING UTILITY POLE ® PROPOSED NEW POLE H 71 EXISTING HANDHOLE H H PROPOSED NEW HANDHOLE [2'x3'] M H EXISTING MANHOLE EH PROPOSED NEW MANHOLE OEXISTING FLOWER POT ® PROPOSED NEW FLOWER POT — — — EXISTING UNDERGROUND UTILITY PROPOSED UNDERGROUND — — — — — — CONSTRUCTION [HAND DIG, BORE] EXISTING AERIAL SPAN PROPOSED AERIAL SPAN CENTER LINE PARCEL LIMITS [PROPERTY LINE] EOP EDGE OF PAVEMENT ROW RIGHT OF WAY WORK DETAILS: ACCESS POLE THEN BORE APPR❑X 110' TO CUSTOMER, BORE WILL NOT CROSS UTILTIES. BORE WILL STAY 5' SEPERATI❑N FROM CITY UTILITES, TRENCH IN UNPAVED AREA I TRENCH IN PAVED AREA I REQUIRED PAVEMENTRESTORATION BEE MILL CREEK STD. PLANS OR AS 6PECIFIED ///--- SAWCVT(TYPIAFPLYJOINT SURFACE RESTORATIONAS SPECIFIED / SEALANT P064-22 TO TOP tY MIN/ AND TACK COATTO SIDES MOUND4"MIN. EXISTING PAVEMENT SURFACE SELECTOR NATIVE TRE iq urc �d <o SACKRLL COMPACT TO 90%NCHOF MAX. DRY DEN." (PER ASTM 4a" �i 0166T) IN UNPAVED AREA 4a SENCHASNEEDEDFOR SHORING ORTRENCH z €f SOx(TYPI WHEN DEPTH IS WAND GREATER !' 3' INITIAL NATIVE SACKFIU- - SELECT (MAX V ROCK) MATERIAL COMPACTED TO 96% MAX. DRY - - - DENSITY.WMAX.LOOSEUFTS r 7 GRAVEL BACKFILL FDR PIPE ZONE MIN. DEPTH IS SPEC 9A39(31. COMPACT TO 116% MAX DRY UENSTTY, SEE NOTE 2 SE LECTOR NATIVE TRENCH SAOKF ILL COMPACT TO 96% MAX. DRY DENSITY (PER A3TM D1557) IN PAVED AREA. PLACED IN 12" MAX LIFTS. BEDDINGPERWSDOT9 12(3) VARIES-- MIN OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY OWNER/CONTRACTOR IS RESPONSIBLE FOR — UTILITIES MAY REQUIRE A SEPERATE PERMIT. EROSION CONTROL AND DRAINAGE 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 ,leU W&J,1,I44z 03/09/2023 VV ATCO COMMUNICATIONS SERVICES, LLC www.otcoteiecom.com 360.563.9000 708 First Street Snohomish, WA 98290 ziPylfiber Everett, WA 98206 o L 1D a u> = U) z O cV �t C/) w O = j z N O N I� Cn w m w � z Q z O ili Q z O w O w U O LU J D- d J LL DATE: 2.23.2023 DESIGNED BY: M. LUNA ATCO CONTACT: 606.369.5721 marcus.luna@atcotelecom.com SCALE: SHEET: NOT TO O' SCALE NO: 1 OF " LEGEND: [ EXISTING TERMINAL FTMI PROPOSED TERMINAL ® EXISTING UTILITY POLE ® PROPOSED NEW POLE H 71 EXISTING HANDHOLE H H PROPOSED NEW HANDHOLE [2'x3'] M H EXISTING MANHOLE EH PROPOSED NEW MANHOLE 0 EXISTING FLOWER POT ® PROPOSED NEW FLOWER POT — — — EXISTING UNDERGROUND UTILITY PROPOSED UNDERGROUND — — — — — — CONSTRUCTION [HAND DIG, BORE] EXISTING AERIAL SPAN PROPOSED AERIAL SPAN CENTER LINE PARCEL LIMITS [PROPERTY LINE] EOP EDGE OF PAVEMENT ROW RIGHT OF WAY WORK DETAILS: O FROM THE POLE RISE DOWN THE POLE AND C❑NTINUE TO CUSTOMER SPOTTER NEEDED FOR PEDESTRIAN TRAFFIC AND DRIVEWAY ACCESS, TRENCH IN UNPAVED AREA TRENCH IN PAVED AREA REQUIRED PAVEM104T RESTORATION BEE MILL CREEK STD. PLANS OR AS 6PECIFIED ///--- SAWCVT(TYPIAFPLYJOINT SURFACE RESTORA71ONASSPECIFIEO / SEALANT P0. TO TOP tY MIN/ AND TACK COATTO SIDES MOUNDR, MIN. EXISTING PAVEMENT SURFACE � iq SELECTOR NATCVETRE urc �d <o SACKRLL COMPACT TO 90%OFNCN MAX. DRY DEN." (PER ASTM q8" �i 01667101 UNPAVED AREA 4a SENCHASNEEDEDFOR SHORING ORTRENCH z €f SOX(TYPI WHEN DEPTH IS WAND GREATER !' 3' INITIAL NATIVE SACKFDUL - SELECT (MAX 1' ROCK) MATERIAL COMPACTED TO 96% MAX. DRY - - - OENSITY,6'MAX. LOOSELIFTS GRAVEL SACKMLL FOR PIPE ZONE MIN MIN SEDDINGPERWSDOTo 12(3) VARIES --I MIN. DEPTH IS SPEC 9A39(31. COMPACT TO N% MAX DRY UENSTTY, SEE NOTE 2 SELECT OR NATIVE TRENCH BAOWILLCOMPACTT096% MAX. DRY DENSITY (PER A3TM D150) IN PAVED AREA, PLACED IN 12" MAX LIFTS. N b RECEIVED JAN 06 2023 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT O ATCO COMMUNICATIONS SERVICES, LLC www.atcotelecom.com 360.563.9000 708 First Street Snohomish, WA 98290 ziPylfiber Everett, WA 98206 N U) 0 U) 0 � z O C,4 �06 w p') H 2 U) 2 F- v N ,;I - CD w w m � o z Q z U U O w w O O U w w O D_ d __J 3 a m r` 0 N N 6i Q z w J_ LL DATE: 1-2-2023 DESIGNED BY: D. KASUSKE ATCO CONTACT: 425.367.2685 derrick.kasuske@atcotelecom.com SCALE: SHEET: NOT TO O' SCALE NO: 1 OF " ATCO COMMUNICATIONS SERVICES, LLC AS THE DESIGNER OF THIS TRAFFIC CONTROL PLAN, MAKES NO REPRESENTATION AS TO ITS' GENERAL ADEQUACY OR BEING APPROVED FOR IMPLEMENTATION. APPROVAL MUST RESULT FROM THE TRAFFIC ENGINEER OR OTHER PUBLIC OFFICIAL HAVING STATUTORY ENFORCEMENT AUTHORITY IN THE JURISDICTION. UTILIZATION AND IMPLEMENTATION OF THIS PLAN SHALL BE A RESULT OF THE APPROVAL. REF. MUTCD 2009 6A - 01 (10) Heather Min Gin Piano store N W A Hazel Apartments 4 34th St SW 234th St SW Naz Auto Sales 1p Car dealer Caliber Collision tl q 19 Another Castle .I � Video Games 61 Video game store Q Aviator Audio U-Haul Neighborhood Dealer Q r-171 234th St SW Access to Money o / O VICINITY MAP p Pacific Park Apartment Homes 7904 234th St SW, Edmonds, WA 98026 234th St SW 7 70% RECEIVED JAN 06 2023 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT O ATCO COMMUNICATIONS SERVICES, LLC www.otcoteiecom.com 360.563.9000 708 First Street Snohomish, WA 98290 ziPylfiber Everett, WA 98206 a � 0) C�0 a Z o v N U 2 0 W oes o N C w co N N w V O O U) Ckf LU U w w m ZQ z w U U O 2 Q Z Of � U ° 0- C DATE: 1-2-2023 REVIEWED BY: D. LAFLEUR WSTCS# 013259 DESIGNED BY: D. KASUSKE ATCO CONTACT: 425.367.2685 derrick. ecom.corr SCALE: SHEET: NOT TO M SCALE 10: 1 OF 2 LEGEND: SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM OS SIGNALIZED INTERSECTION OCONE (CANDLESTICK) ® TYPE III BARRICADE WORKTRUCK WORK ZONE LIMITS OWE WARNING SIGN ARROW BOARD REQUIRED) (WHERE DIRECTION OF TRAFFIC (NOT PAVEMENT MARKINGS) FLAGGER (AS NEEDED) ATCO COMMUNICATIONS SERVICES, LLC AS THE DESIGNER OF THIS TRAFFIC CONTROL PLAN, MAKES NO REPRESENTATION AS TO ITS' GENERAL ADEQUACY OR BEING APPROVED FOR IMPLEMENTATION. APPROVAL MUST RESULT FROM THE TRAFFIC ENGINEER OR OTHER PUBLIC OFFICIAL HAVING STATUTORY ENFORCEMENT AUTHORITY IN THE JURISDICTION. UTILIZATION AND IMPLEMENTATION OF THIS PLAN SHALL BE A RESULT OF THE APPROVAL. REF. MUTCD 2009 6A - 01 (10) SIGN LEGEND: ROAD ONE LANE WORK ROAD AHEAD AHEAD W20-1 W20-4 W20-7A 19 19 / %r0 ell •pp_ wzo__ BUFFER AREA LONGITUDINAL BUFFER SPACE = B POSTED SPEED (MPH) 25 30 35 40 45 50 55 60 64 70 LENGTH (feet) 155 200 250 305 360 425 495 570 645 730 TRANSPORTABLE ATTENUATOR ROLL AHEAD DEVICE = R HOST VEHICLE WEIGHT (Ibs) 9,900 TO 22,000 HOST VEHICLE WEIGHT (Ibs) > 22,000 < 45 MPH 45 - 55 MPH > 55 MPH < 45 MPH 45 - 55 MPH > 55 MPH 100, 123' 172' 74' 100, 150' PHASE 1 WORK DETAILS: Oj FROM THE POLE RISE DOWN THE POLE AND C❑NTINUE TO CUSTOMER SPOTTER NEEDED FOR PEDESTRIAN TRAFFIC AND DRIVEWAY ACCESS, TRAFFIC CONTROL INSPECTION SHALL BE REQUIRED WHENEVER WORK ZONE IS SET UP ONE LANE, TWO WAY 50'-100' TRAFFIC TAPER a 10' MIN. 234TH ST SW (25 MPH) 50'-100' TRAFFIC TAPER NOTE: MON. - FRI. = 7:00am TO 4:00pm CHANNELIZATION DEVICE SPACING (feet) MPH TAPER TANGENT 50/70 40 80 35/45 30 60 25 / 30 20 40 MINIMUM SHOULDER TAPER LENGTH = L/3 (feet) SHOULDER POSTED SPEED (MPH) WIDTH (feet) 25 30 35 40 45 50 55 60 65 70 8 40 40 60 90 120 130 150 160 170 190 10 40 60 90 90 150 170 190 220 220 240 USE A MINIMUM 3 DEVICES TAPER FOR SHOULDER LESS THAN 8' ENGINEERING DIVISION APPROVED AS NOTED jell LVIgl&uwg 03/09/2023 VV CYO RECEIVED JAN 06 2023 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT SIGN SPACING = X (1) FREEWAY & EXPRESSWAYS 55 / 70 MPH 1500' ± RURAL HIGHWAYS 60 / 65 MPH 800' ± RURAL ROADS 45 / 55 MPH 500' ± RURAL ROADS & URBAN ARTERIALS 35 / 40 MPH 350' ± RURAL ROADS & URBAN ARTERIALS 25 / 30 MPH RESIDENTIAL & BUSINESS DISTRICTS 200' ± (2) URBAN STREETS 25 MPH OR LESS 100'± (2) (1) ALL SPACING MAY BE ADJUSTED TO ACCOMMODATE INTERCHANGE RAMPS, AT -GRADE INTERSECTIONS AND DRIVEWAYS (2) THIS SPACE MAY BE REDUCED IN URBAN AREAS TO FIT ROADWAY CONDITIONS. O ATCO COMMUNICATIONS SERVICES. LLC www.otcoteiecom.com 360.563.9000 708 First Street Snohomish, WA 98290 ziPylfiber Everett, WA 98206 rl- N ¢ C04 3 0 o N z ~ 0 � N W C/) M Z N 1 I ^ L U) H M O N v o rn L� ^z z O U U w w m 0 7) z U o Q U z O CZiL z Of of U o D_ C DATE: 1-2-2023 REVIEWED BY: D. LAFLEUR WSTCS# 013259 DESIGNED BY: D. KASUSKE ATCO CONTACT: 425.367.2685 derrick.kasuske@atcotelecom.com SCALE: SHEET: =5C 02 NO: 2OF2 RECEIVED CITY OF EDMONDS Right -of -Way Application #1249055 - 162207 / JAN 06 2023 MyBuildingPermit.com CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT Applicant First Name Last Name Company Name Caitlin Reid Ziply Fiber Number Street Apartment or Suite Number E-mail Address 1800 41st St Ste N-100 caitlin.reid@Ziply.com City State Zip Phone Number Extension Everett WA 98203 (425) 261-6488 Contractor Company Name PACIFIC CABLE CONSTRUCTION INC Number Street Apartment or Suite Number PO Box 573 City State Zip Phone Number Extension Woodinville WA 98072 (425) 348-7735 (206) 730-5945 State License Number License Expiration Date UBI # E-mail Address PACIFCC954PJ 10/21/2023 FDD5877Dq caitlin.reid@Ziply.com Project Location Number Street Floor Number Suite or Room Number 7904 234TH ST SW City Zip Code County Parcel Number EDMONDS 98026 00576700002901 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 J W J\k M\goos Tm\I D Ttee Therrell Number Street Apartment or Suite Number PO BOX 2002 City State Zip BOTHELL WA 98011 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: 1/5/2023 Submitted By: Caitlin Reid Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Right -of -Way Application #1249055 - 162207 Project Contact Company Name: Ziply Fiber Name: Caitlin Reid Email: caitlin.reid@Ziply.com Address: 1800 41st St Ste N-100 Phone #: (425) 261-6488 Everett WA 98203 Project Type Activity Type Scope of Work Utility Purveyor Utility Work No Disturbance of Surface Project Name: 162207 Description of Work: excess the pole riser down from pole than continue to customer Project Details Project Information Job Number 162207 Page 2 of 2