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ENG2023-0191 ROW PERMIT�~ o� RIGHT OF WAY EUC PERMIT o f EdmondsCity of Edmonds PERMIT NU M 98020 1 1 • ww w.edmondswa.govi Description: ZIPLY - TRANSFER LINES TO NEW POLE AND REMOVE OLD POLE ISSUED: 05/04/2023 Address: 23805 79TH AVE W EDMONDS WA 98026-9282 EXPIRES: 11/04/2023 Permit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00548600001700 CONTACTS NAME TYPE NAME ADDRESS PHONE APPLICANT VICTORIA COMER 1800 41ST STREET STE N-100, EVERETT WA 98203 (830)513-6614 CONTACT ZIPLY FIBER 1800 41ST STREET STE N-100, EVERETT WA 98203 (830)513-6614 CONTRACTOR ZIPLY FIBER 1800 41ST ST, EVERETT WA 98201 (425)949-0230 OWNER SANDRA R LOPEZ 23805 79TH AVE W, EDMONDS WA 98026-9282 FEE INFORMATION DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE - PER PERMIT $45.00 $45.00 ENG - INSPECTIONS $252.00 $252.00 RIGHT-OF-WAY PERMIT - STANDARD $378.00 $378.00 REQUIREMENTSJIL 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: 05/04/2023 Printed: Thursday, May 04, 2023 9:38:14 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 E-7 TRAFFIC CTRL X-2 ENGINEERING FINAL" Printed: Thursday, May 04, 2023 9:38:14 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. APR 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 Info Project Name 5235586-377 Site Address or if no site address use Property Address at NW corner of project area: 23805 79TH AVE W, EDMONDS 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 PointofContact Mike Hakahan Title Engineer Address1800 41 st St., Ste. N 100 city Everett State WA zip 98203 Phone 425-949-0230 Email mike.hakahan@ziply.com AuthorizedContractor and Agent •below) Name of Company Ziply Fiber Northwest, LLC Primary Name Mike Hakahan Agent Name Mike Hakahan Title Engineer Title Engineer Mobile 425-949-0230 Addressl800 41st St. Ste. N100 Email mike.hakahan@ziply.com city Everett I State WA zip 98203 Secondary Name Phone 425-949-0230 Title Email mike.hakahan@ziply.com Mobile City of Edmonds Business License No: 313-013-420 Email State License No: ZIPLYFN782L3 I1 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) ❑ 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 PUD WILL PLACE NEW POLE, ZIPLY WILL TRANSFER <1> ATTACHMENT THEN REMOVE EXISTING POLE. 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 Details 1. of Work to be Completed Does the utility owner have existin 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? / V 5. Does the work involve proposed additions to an aboveground utility 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? Details of • to be Completed ni 6. Does your project involve rebuilding or replacing utility equipment which currently serves more ry 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: _ / V How man are existing? How man 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? N/A 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: How many? What is the height of the poles after? Mimi 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: Na&6z,L_� APPLICANT PRINTED NAME: MARCUS LUNA APPLICANT TITLE: TCP SPECIALIST NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE 4/6/2023 City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM LEGEND: EXISTING UTILITY POLE ® PROPOSED NEW POLE r WORK DETAILS-. PUD WILL PLACE NEW POLE, ZIPLY WILL TRASFER <1> ATTACHMENT THEN REMOVE EXISTING POLE, , t jc! �, ; ,r^ dr r r a f 23804 ' � •;;� $4d A ENGINEERING DIVISION APPROVED AS NOTED Jell (Al&J,,$,44e 05/03/2023 Vill 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. P ' T RECEIVED APR 07 2023 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT �. ziPylfiber Everett, WA 98206 t U 3 M Z �' ! 00 U 0 NLO = W W 00 > i 0 W otS W y r ! Q � F_ d Z LO ao Y 00 >� M N q i L! W LO U, cn N l' LO ` c J • �. W W 'SI m p Z Q I— 0 W Q Z O O U LU a a J OE �.1-1 � P'1614;m a► OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING OWNER/CONTRACTOR IS RESPONSIBLE FOR ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY EROSION CONTROL AND DRAINAGE UTILITIES MAY REQUIRE A SEPERATE PERMIT. 0 I I t—OZM 0 NVO �—OZM ENGINEERING DIVISION APPROVED AS NOTED jdl, 05/03/2023 vv 1N3Ni2lVd30 S301A213S 1N3WdMDA30 SaNOW43 d0 AilO £ZOZ LO NdV C13AI303N 2JlldVl Olddd2ll �I]IdVl OIddVa <—,—'NIW J I, —> L-Oz (HdIw -P�, z) TRAFFIC CONTROL INSPECTIOP REQUIRED WHENEVER WORK I SCHEDUI RECEIVED CITY OF EDMONDS Right -of -Way Application #1294874 - 5235586-377 APR 07 2023 MyBuildingPermit.com CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT Applicant First Name Last Name Company Name Victoria Comer Ziply Fiber Number Street Apartment or Suite Number E-mail Address 1800 41 ST Street Ste N-100 victoria.comer@ziply.com City State Zip Phone Number Extension Everett WA 98203 (830) 513-6614 Contractor Company Name ZIPLY FIBER NORTHWEST LLC Number Street Apartment or Suite Number 1220 75th St SW City State Zip Phone Number Extension Everett WA 98203 (425) 231-3928 State License Number License Expiration Date UBI # E-mail Address ZIPLYFN782L3 5/25/2024 iyini i4gn caitlin.reid@Ziply.com Project Location Number Street Floor Number Suite or Room Number 23805 79TH AVE W City Zip Code County Parcel Number EDMONDS 98026 00548600001700 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 Sandra R Lopez Number Street Apartment or Suite Number 23805 79TH AVE W City State Zip EDMONDS WA 98026-9282 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: 4/6/2023 Submitted By: Victoria Comer Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Right -of -Way Application #1294874 - 5235586-377 Project Contact Company Name: Ziply Fiber Name: Arianne Mommsen Email: Arianne.Mommsen@Ziply.com Address: 1800 41 ST Street Ste Phone #: (830) 513-6614 N-100 Everett wa 98203 Project Type Activity Type Scope of Work Utility Purveyor Utility Work No Disturbance of Surface Project Name: 5235586-377 Description of Work: PUD WILL PLACE NEW POLE, ZIPLY WILL TRASFER <1> ATTACHMENT THEN REMOVE EXISTING POLE. Project Details Project Information Job Number 5235586-377 Page 2 of 2