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ENG2023-0201 ROW PERMIT�~ o� RIGHT OF WAY EUC PERMIT o fIM EdmondsCity of Edmonds PERMIT NUIMVI 980201 1 1 -.mondswa.gov / 425.771.022i Description: ZIPLY - TRANSFER LINES TO NEW POLE AND REMOVE OLD POLE ISSUED: 05/25/2023 Address: 1141 VIEWLAND WAY EDMONDS WA 98020-2581 EXPIRES: 11/25/2023 Permit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00606600001800 CONTACTS NAME TYPE NAME ADDRESS PHONE APPLICANT VICTORIA COMER 1800 41ST STE. N-100, EVERETT WA 98203 (830)513-6614 CONTACT ZIPLY FIBER 1800 41ST STE. N-100, EVERETT WA 98203 (402)670-8384 CONTRACTOR ZIPLY FIBER 1800 41ST ST, EVERETT WA 98201 (425)949-0230 OWNER PETER D & MAUPIN TERR CROUCH 1141 VIEWLAND WAY, EDMONDS WA 98020-2581 FEE INFORMATION DI S III iJi qAMOUNT 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: 05/25/2023 Printed: Thursday, May 25, 2023 2:49:42 PM 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 25, 2023 2:49:42 PM 2 of 2 Lti�y of EpiyO�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. RECEIVED APR 12 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 iaan0000 1001 Site Address or if no site address use Property Address at NW corner of project area: 11141 VIEWLAND WAY, 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 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 0 Contractor verifies it is currently bonded Contractor verifies it currently has general liability insurance 1VU1h: 1 CDC 18.60.020 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) X❑ Traffic Control Only (no associated development) City of Edmonds ROW construction permit Application --Page 1 of 3 Updated 3/25/2021 ry]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 NUU WILL PLACE NEW NULL, ZINLY I U I RANSFER (L) ATTACHMENTS, (1) 2' RISER, (2) BSW, (2) DOWN GUYS 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 1. CompletedDetails of Work to be Does the utility owner have existing overhead infrastructure in the area of work? • 2. Will any equipment be added underground or above ground (e.g. 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 system? 5. Does the work involve proposed additions to an aboveground utility system? If es: X 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: El How many are existing? How many are to be added? 6b. Does your project involve poles? I yes: 0 How many poles are existing in the project area? What is the height of the existing poles? n r_1 How many poles are to be removed? Are additionalpoles to be laced? X 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? Describe the modification rebuild: PUD WILL PLACE NEW POLE, ZIPLY TO TRANSFER (2) ATTACHMENTS, (1) Z RISER, (2) BSW, (2) DOWN GUYS THEN REMOVE EXISTING POLE. 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: �� DATE: 4/11 /2023 Moises Rivera APPLICANT PRINTED NAME_ TCP Specialist APPLICANT TITLE: NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 CONSTRUCTION NOTES O AT POLE PLI 414 EXISTING 45' CLASS 2 POLE SET 45' CLS 2 POLE TIGHT SOUTH AS STAKED (PW2045) INSTALL GROUND PLATE (NO110) INSTALL 10 VERTICAL DOUBLE DEADEND ASSY (12V110) INSTALL (2)8" SINGLE HELIX ANCHORS DUE SOUTH AND DUE EAST AS STAKED L=7 FEET (AO101) INSTALL (2) 3/8 INCH PRIMARY DOWNGUYS (GO113) INSTALL 37.5KVA OH TRANSFORMER (BA21P)(12V601) INSTALL 10A FUSE (E1010) UTC#---------------- SER#---------------- SEC VOLT ---------------- TRANSFER EXISTING SECONDARY SERVICES INSTALL NEW 8' STREET LIGHT MAST (L0503) TRANSFER EXISTING LED LUMINAIR FROM OLD POLE AT OLD POLE: REMOVE OLD 37.5KVA OH TRANSFORMER UTC#---------------- SER#---------------- REMOVE PUD GUY WIRES AND LEAVE OTHER GUYWIRES AND ANCHOR TO OTHERS TOP OFF AND ABANDON POLE TO OTHER UTILITIES Strip, top and abandon 0 FU40 L 128596 B 411 FU40 N 15-3 135 `� 4151 1141 1180 2565 37-6909 414 -- — — —— — --— -- — — ————— — — — --— -- 7. G v1 EwLaN6 wv 1152-M-CDG 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. 154 45-59 Comcast 5063 ENGINEERING DIVISION APPROVED AS NOTED Jd] 05/18/2023 VV N NORTH I RECEIVED APR 12 2023 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT SNOHOMISH COUNTY L_pLu i❑ PUBLIC UTILITY DISTRICT NO 1 1112 Rev. 7/10 ORIGINAL APPENDIX A JOINT POLE NOTIFICATION S 2,158.29 2020 Yeor Price List To CATV: FRONTIER Exchange Date —' l� U z Z1PLY COMCAST 2100 3/1/2021 cn MO Customer Name BO Pole Service Address 0 0 z 7 n SNOHOMISH COUNTY PUD 1141 VIEWLAND WAY, EDMONDS WA 98020 �O I N PUD WO/Task No. PUD Engineer PUD Approved z ~ un c� 100074071-30 RICHARD DUMO 425-783-5110 PUD INTENDS TO PERFORM THE FOLLOWING ON THIS WORK ORDER: out ❑Set Poles ❑Set Additional 8" Helix Anchors 3/4/2021 ® Replace 1 Poles ❑ Set Additional 12'' Helix Anchors In ❑ Eliminate Poles From PUD System ❑ Customer Pay 100% Contacts Free To FRONTIER ❑ PUD To Contact FRONTIER Pole(s) At Locations) BM Number Other FRONTIER Pay 45% Of The Following (Estimates Only) PUD Work Completed Easement Estimate FRONTIER Transfer 0 y CATV Transfer y Replace BO Pole - PLI 414 SEE DRAWING OWNER/CONTRACTOR IS RESPONSIBLE FOR EROSION CONTROL AND DRAINAGE 3/8 - Ziply Crew to: Return to Joint Use By Transfer 2 attachments 3/14/21 Transfer 2" Riser Transfer 2 BSW's Transfer 2 Downguys OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY 2 Flaggers UTILITIES MAY REQUIRE A SEPERATE PERMIT. ZIPLY = 45% OF A 45' POLE yes FOR FRONTIER USE ONLY NFRONTIER ACCEPTS THE FOLLOWING [:]NO JOINT USE Pole/Location Reference (n o N S C -0 0 Size Recovery (Size/Year) Cost Pole/Location Reference - N o N CRecovery C o Size (S Size/Year) Cost � w < � W Q 414 X 45 (45/59) 2,158.2 Additional Anchors At The Following Locations WO/USDA Codes Fielded By: Date: 3/14 Donavon LaFleur Ap roved By, Date: �� Giv�. 3/16/21 LEGEND: WORK DETAILS: RECEIVED EXISTING UTILITY POLE 2D ATTACHMENTS, WILL PLACE N ACHENS,N lW 2'❑RISER,P(2) BSWRA2�FER APR 12 2023 DOWN GUYS THEN REMOVE EXISTING POLE. ® PROPOSED NEW POLE CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT NEWT zipYlfiber V F • Everett, WA 98206 r of l • 4% � w 3 1 • .� r N = ~ �• 00 in Z _ Lo o N os Q Y W o z 00 1� Z >¢ ILL N >J > LPL co f ! > co w > Lo Lo -_� • O IV • , • • ♦ _ w W m • cl W z Q W W O Z y ° ° o Lu DATE: 04.06.2023 DESIGNED BY: L.MATEO SCALE: SHEET: N 0 T TO - SCALE O N0: 1 OF 1 1121 12thAve N Edmonds. Washington • Google Street View Jul 2022 See more dates r � . Ait�' • "MIT —14 Image capture: Jul 2022 0 2023 Google United States Terms Privacy Report a problem LEGEND: SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM OSIGNALIZED INTERSECTION OCONE (CANDLESTICK) ® TYPE III BARRICADE WORKTRUCK WORK ZONE LIMITS OWE WARNING SIGN ARROW BOARD REQUIRED) (WHERE DIRECTION OF TRAFFIC (NOT PAVEMENT MARKINGS) FLAGGER-SPOTTER FLAGGER STATION D/W 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) WORK DETAILS: PUD WILL PLACE NEW POLE, ZIPLY TO TRANSFER (2) ATTACHMENTS, (1) 2' RISER, (2) BSW, (2) DOWN GUYS THEN REMOVE EXISTING POLE, SPOTTER NEEDED FOR PEDESTRIAN TRAFFIC AND DRIVEWAY ACCESS, VIE WLAND WA Y D/W N (25 MPH) 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' W20-1 PHASE 1 TRAFFIC CONTROL INSPECTION SHALL BE REQUIRED WHENEVER WORK ZONE IS SET UP CYO W20-4J to ENGINEERING DIVISION APPROVED AS NOTED W20-7A 4 X X X ^lQI/ (,il1..gj,,..04p 05/18/2023 W20-7A-\ W20-4-\ W20-1-\ VV a ' " ' RECEIVED => APR 12 2023 DIW Z Q O U J �' O d Z0o�� 0 ' joj WORK AREA 7A NOTE: MON. - FRI. = 7:00am TO 4:00pm ONE w P VIE WLAND WA Y (25 MPH) SIGN LEGEND: SR PpER CHANNELIZATION DEVICE SPACING (feet) MPH TAPER TANGENT 50/70 1 40 1 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' ROAD ONE LANE WORK ROAD AHEAD AHEAD W20-1 W20-4 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT <i> W20-7A 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 00 Q O c\I Uj N00 ❑ o z 0 L LU Q z J w IY w m z I— U w 0 li u w IY Q U w 0 D- z 0 Q U 0 _J W 0) 3 d 0 I— w N N 00 M O L0 tii Q z w _J LL DATE: 4.10.2023 REVIEWED BY: D. LAFLEUR WSTCS# 013259 DESIGNED BY: M. RIVERA ATCO CONTACT: 214.259.6514 moises.rivera®atcotelecom.com SCALE: SHEET: =5C 02 NO: 2OF2 ATCO COMMUNICATIONS SERVICES, LLC AS THE DESIGNER OF THIS TRAFFIC CONTROL PLAN, N 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) Al ft O ATCO COMMUNICATIONS SERVICES, LLC www.otcoteiecom.com Just- F,l owers 360.563.9000 Florist 708 First Street Snohomish, WA 98290 O` 0 ziPIy f i ber Everett, WA 98206 Excelsior PI irtofina t E3ar9 Olympic View Deli Shell Puget Dr � puget Dr S .g Sol utians Digital Marketing n' Edmonds Elementary School 9 Viewland Way 0 10th Ave N 1 72. � m Z 19 Schrader Co Sales Argonaut Diving 0 Viewlcand 'Way VICINITY MAP Puget Dr WORK AREA PURE RECEIVED APR 12 2023 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT N o 1 a o o � O N ~ o 06 0o 00 Q00 a N z a o Lr)L1J Z wW W > C/') Ckf LLJ O U W W m rr z o a z 6i U U O 2 a Z Of � 0 0- d LL DATE: 4.10.2023 REVIEWED BY: D. LAFLEUR WSTCS# 013259 DESIGNED BY: M. RIVERA ATCO CONTACT: 214.259.6514 moises.rivera@atcotelecom.com SCALE: SHEET: T T� 01 S� A E NO: 1 OF 2 RECEIVED CITY OF EDMONDS Right -of -Way Application #1297710 - 5503822-188 APR 12 2023 MyBui ldi ngPermi t. 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 41st Ste. N-100 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 1800 41 st Ste. N-10- City State Zip Phone Number Extension Everett WA 98203 8305136614 State License Number License Expiration Date UBI # E-mail Address ZIPLYFN782L3 5/25/2024 iyini i4gn victoria.comer@Ziply.com Project Location Number Street Floor Number Suite or Room Number 1141 VIEWLAND WAY City Zip Code County Parcel Number EDMONDS 98020 00606600001800 Associated Building Permit Number Tenant Name 5503822-188 Additional Information (i.e. equipment location or special instructions)_ Work Location Property Owner First Name Last Name or Company Name Peter D & Maupin Terri K Crouch Number Street Apartment or Suite Number 1141 VIEWLAND WAY City State Zip EDMONDS WA 98020-2581 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: 4/11/2023 Submitted By: Victoria Comer Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Right -of -Way Application #1297710 - 5503822-188 Project Contact Company Name: Ziply Fiber Name: Arianne Mommsen Email: arianne.mommsen@Ziply.com Address: 1800 41 st Ste. N-100 Ste Phone #: (402) 670-8384 N-100 Everett WA 98203 Project Type Activity Type Scope of Work Utility Purveyor Utility Work No Disturbance of Surface Project Name: 5503822-188 Description of Work: PUD will place new pole then Ziply will transfer (2) attachments, (1) 2' riser, (2) BSW, (2) down guys then remove the existing pole. Project Details Project Information Job Number 5503822-188 Page 2 of 2