ENG2022-0606 ROW PERMITo� e pM
RIGHT PERMIT
City of Edmonds PERMIT NUM
Edmonds A':1 1 06�•
www.edmondswa.gov / 425.1 1
Description: ROW IMPROVEMENTS FOR SELECT SP PLN2021-0038
ISSUED: 04/27/2023
Address: 8929 220TH ST SW EDMONDS WA 98026-8139
EXPIRES: 04/27/2024
Permit Type: RIGHT OF WAY Permit Subtype: SUBDIVISION Parcel Number: 00380300101000
CONTACTS
NAME TYPE NAME ADDRESS PHONE
APPLICANT CINDY HINSON 8304 212TH ST SW, EDMONDS WA 98026 (452)742-6044
CONTACT SELECT HOMES 8304 212TH ST SW, EDMONDS WA 98026 (452)742-6044
CONTRACTOR SELECT HOMES INC 8304 212th ST SW, EDMONDS WA 98026 (425)742-6044
OWNER SELECT HOMES INC 8304 212TH ST SW, 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
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.
94
RELEASED BY: MAJ DATE: 04/27/2023
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o� e pM
RIGHT PERMIT
City of Edmonds PERMIT NUM
Edmonds A':1 1 06�•
www.edmondswa.gov / 425.1 1
CONDITIONS
CONDITION TYPE
NOTES
48 HRS NOTICE-ENGR FINAL
48 Working hours notice is required when requesting your FINAL engineering inspection.
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.
INSP PRIOR TO BACKFILL
Call for all required inspections. All work shall be inspected prior to backfill.
SCHEDULE REQUIRED INSPECTIONS AS NOTED THROUGH MY BUILDING PERMIT.
INSPECTIONS
www.mybuildingpermit.com
This property falls within the Olympic View Water and Sewer District. A permit from Olympic View is
OVWSD SEWER LATERAL
required for the sewer lateral installation.
This property falls within the Olympic View Water and Sewer District. A permit from Olympic View is
OVWSD SEWER SERVICE
required for the sanitary sewer installation.
Electronic civil asbuilt shall be submitted to the City prior to final project acceptance. Asbuilt shall be
PROJECT CIVIL ASBUILT
submitted to Engineeringpermits@edmondswa.gov.
RESTORE LANDSCAPE
Restore landscape to like or better conditions
ROW COMPACTION TEST
Right of way compaction tests are required per City standards.
SEWER AND WATER
MAINTAIN 10 FEET OF SEPARATION BETWEEN THE SANITARY SIDE SEWER AND THE WATER SERVICE
SEPARATION
LI N E.
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.
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
X-2 ENGINEERING FINAL"
A-1 ENGINEERING PRECON
A-1 TESC AND MOBILIZE
E-7 CONCRETE SIDEWALK
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ov EDM
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f PERMIT NUM
City of Edmonds
D!
www.edmondswa.gov
E-7 CURB GUTTER
E-7 DRY UTILITY LOCATION
E-7 DWY APPROACH
E-7 MAILBOX LOCATION
E-7 PAVEMENT COMPACTION TEST
REPORT
E-7 PVMT SUBGRADE
E-7 RESTOR LIMITS
E-7 STRIPING
E-7 TRAFFIC CTRL
E-7 TREE GRATE
E-7 WATER TAP AND SRV
X-0 OVWSD APPROVAL
E-7 STORM CB
Printed: Thursday, April 27, 2023 12:40:12 PM 3 of 3
MS is u
RIGHT OF WAY CONSTRUCTION
PERMIT APPLICATION
1N3"iHVd30
S301na3S 1N3Wd013A30
Complete and submit this Application in accordance with IiieO1Nbmi{Ral
Requirements outlined in Right -of -Way permit HandoutW ZZ 024
If any field is not applicable to your project, write "N)Q,3 tAilc3Qw3?4g blank.
All fields required. Incomplete Applications will be denied.
SECTION A
General•
Project Name p�?5+
W6Vftss991W Hvtl" use Property Address at NW corner of project area: �!
Associated Permits: BLD ... PLNoa� ENG
Owner and Entity Holding
Name of Company 5/�C applicable) G� n� Franchise Ordinance No:
Point of Contact
Title
I
Address
City
State
Zip D�P
Phone
Email
Contractor• Authorized Agent of •wner (see note • •w)
Name of Company
Contractor ContactsDuring Construction
Primary Name Q� J
Title v!' �• n
Agent Name
Title
Mobile
Address
Email �L
City
State
Zip
Secondary Name
Phone
Title
Email
Mobile
City of Edmonds Business license No: R 2 1
Email
State License No:4::16 . Lz < 14 A
Contractor verifies it is currently bonded
Contractor verifies it currently has general liability insurance
NOTE. ECDC 18.6o.o2o requires that the Application be signed by a licensed and bonded conb-actor unless otherwise approved by the city
engineer.
Type of Development — Clieck ALL that apply
❑ Multifamily residential ❑ Commercial ❑ City project
O?eingle 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 welll
❑ Traffic Control Only (no associated development)
City of Edmonds ROW construction permit Application --Page 1 of 3
Updated 3/25/2021
9$o'-2,
Z 4e)4A,
❑ Utility Franchise Work (no associated development)
PrQject 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.)
M `aalennuaJols
o gino ssome
,6eluoii Ilelsul
RIGHT-OF-WAY
CLOSURE
AREA
TOTAL
DURATION
(Number of Months)
Sidewalk 72 hours +
LF
x LF
SF
Alley 2 hours + o LF
S
LF
oss sq;uoua �+
Parking 72 hours + LF
x LF
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 x ❑ sewer x ❑ storm
x
Details of Work to be Completed
1. 1 Does the utility owner have existing overhead infrastructure in the area of work?
Yes
No
2. 1 Will any equipment be added underground or above ground e.. pedestals, vaults etc.)?
If yes, describe:
3.
Does the proposed work connect a lot or commercial development with utilities that seine more
than one lot or commercial development?
4.
Does the work involve rebuilding or relocating an existing aboveground utility system which x
connects a lot or commercial development to an existing underground common utility system?
15.
Does the work involve proposed additions to an aboveground utility system? If es: x
Are the additions for the purpose of sei ving new commercial development?
Are the additions for the purpose of sei ving a single-family residential subdivision?
Details of • to be CompletedNo
6. Does your project involve rebuilding or replacing utility equipment which currently serves more
than one lot or commercial development?
x
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 additional poles to be laced?
How many? What is the height of the additionalpoles?
_
6c.
Are any poles to be modified/rebuilt/replaced? If yes:
How many? What is the height of the poles after?
17
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 perjuiy 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: DATE:
UOSUIH �pul) azoaizaia�
APPLICANT PRINTED NAME:
APPLICANT TITLE:
;ue;Sissy `0ax3 'oul S9WOH 10919E
uosuiH Apu10
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021
RECEIVED
Dec 22 2022
MyBU1�d1rIP,,PerIT11t.COnIDEVELOPMEN SO
CITY OF EDMNDS
CITY OF EDMONDS ERVCES
DEPARTMENT
Right -of -Way Application #1245201 - Select Homes 2-Lot Short Plat
Applicant
First Name Last Name Company Name
Cindy Hinson Select Homes
Number Street Apartment or Suite Number E-mail Address
8304 212th St SW cndy@selecthomeswa.com
City State Zip Phone Number Extension
Edmonds WA 98026 (452) 742-6044
Contractor
Company Name
Select homes inc
Number Street Apartment or Suite Number
8304 212th St SW
City State Zip Phone Number Extension
Edmonds WA 98026 2067300670
State License Number License Expiration Date UBI # E-mail Address
SELECH1110KN 1/2/2023 FD1 usgsn gary@selecthomeswa.com
Project Location
Number Street Floor Number Suite or Room Number
8929 220TH ST SW
City Zip Code County Parcel Number
EDMONDS 98026 00380300101000
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
SELECT HOMES INC
Number Street Apartment or Suite Number
8304 212TH 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: 12/22/2022 Submitted By: Cindy Hinson
Page 1 of 2
CITY OF EDMONDS MyBuildingPermit.com
Right -of -Way Application #1245201 - Select Homes 2-Lot Short Plat
Project Contact
Company Name: Select Homes
Name: Cindy Hinson Email: cndy@selecthomeswa.com
Address: 8304 212th St SW Phone #: (452) 742-6044
Edmonds WA 98026
Project Type Activity Type Scope of Work
Subdivision New Excavation and Utility Work
Project Name: Select Homes 2-Lot Short Plat
Description of Work: 2-Lot Short Plat with utility and frontage improvements.
Project Details
Project Information
Driveway Access
Sidewalk Improvements
Storm Drainage Tie -In
Utility Service Installation
Impervious Surface
Adding/Replacing 2,000 square feet or more of hard
surface
Clearing and Grading Information
This is new development
Tree Removal
There are more than five significant trees removed
Page 2 of 2
r /
MyBuildingPermitxom
Jurisdiction: Edmonds
Project Name: Select Homes 2-Lot Short Plat
Application ID: 1245201
Supplemental Name: Authorization and Acknowledgment - Right of Way
I acknowledge that only a Licensed and Bonded Contractor can work in the Right -of -Way.
Yes, I acknowlege
All provisions of laws and ordinances governing this type of work will be complied with. I further agree to hold harmless the City of
Edmonds as to any claim (including costs, expenses, and attorney's fees incurred in investigation and defense of such claim), which
may be made by any person, including the undersigned, and filed against the City of Edmonds, but only where such claim arises out
of the reliance of the City, including its officers and employees, upon the accuracy of the information supplied to the City as part of
this application.
I hereby authorize the City representatives to inspect the property Monday -Friday between the hours of 8:00 a.m. and 5:00 p.m.
during this permit application process for verification of site conditions.
I certify, under the penalty of perjury under the laws of the State of Washington, that the information and exhibits herewith submitted
are true and correct to the best of my knowledge, and that I am the owner or am authorized by the owner, to file this application on
their behalf for the subject property.
Yes, I authorize
Electronic documents submitted to the City of Edmonds for plan review and permit issuance must be provided in a format that
does not prevent the City from making code comments on the documents during review or from making the documents ready for
permit issuance. Documents submitted in any manner that prevents the City from completing the review and permit issuance
process, including but not limited to submitting documents that are locked, may result in additional review time, permitting
delays, and/or cancellation of the permit application if the problem is not resolved by the applicant in a timely manner.
Please refer to chapter 18.43 RCW, chapter 18.210 RCW, chapter 1 96-23 WAC and chapter 1 96-33 WAC for Washington State
laws governing electronic documents. An interpretative guideline from the Board of Registration for Professional Engineers and
Land Surveyors can be found at http://www.dol.wa.gov/business/engineerslandsurveyors/docs/eDocslnterpretiveGuideline.pdf.
These laws and requirements are subject to change and the submitting parties are responsible for keeping apprised of any such
changes.
Please acknowledge that you understand these requirements and have verified the electronic documents being submitted meet
the City of Edmonds submittal requirements by checking the box below. If you have questions, contact the Engineering
Division at engineeringpermits@edmondswa.gov or 425-771 -0220.
Yes, I acknowledge
The City of Edmonds makes permit applications available to the public in an effort to make its processes as transparent as
possible. By signing or initialing this document, I acknowledge that any and all information submitted as part of this application,
is public information. I further acknowledge and agree that this permit application, and any and all documents related
thereto, may be disclosed by the City of Edmonds to the public without redaction.
Please provide electronic signature below:
Robert Long