ENG2023-0243 ROW PERMIT�~ o� RIGHT OF WAY EUC PERMIT
o
f
City of Edmonds PERMIT NU M
121 5th Ave N, Edmonds WA 98020 ENG2023-02AI
www.edmondswa.gov i
Description: PSE - NEW GAS SERVICE WITH PAVEMENT CUTS
ISSUED: 05/26/2023
Address: 7918 203RD ST SW EDMONDS WA 98026-6853
EXPIRES: 11/26/2023
Permit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 27041900112700
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 SELECT HOMES INC 8304 212TH ST SW, EDMONDS WA 98026
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
JIL 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: 05/26/2023
Printed: Friday, May 26, 2023 9:21:53 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
X-2 ENGINEERING FINAL"
E-7 RESTOR LIMITS
Printed: Friday, May 26, 2023 9:21:53 AM 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�.
May 04 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 io6388977
Site Address or if no site address use Property Address at NW corner of project area: 7918 203 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.)
Install gas service at approx 16' to 3.' N C/1 of 203rd ST SW & 914' W c/l of 77th Ave w (1) 3X5 GRASS & (1) 3X3
PAVING CUT ANTICIPATED
RIGHT-OF-WAY
CLOSURE
AREA
TOTAL
DURATION
(Number of Months)
Sidewalk 72 hours +
LF
I x
LF
SF
Alley 72 hours +
LF
Ix
I LF
SF
Parking 72 hours +
LF
Ix
I LF
SF
1
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 3xgas
❑ 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: 05/03/23
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
Puget Sound Energy Gas Pre -Inspect Form
Job #:
106388977
Service Address:
7918 203RD ST SW
Date:
8/17/22
City
EDMONDS
Zip: 98026
Jurisdiction:
EDMONDS
Customer:
GARY KLICK
Phone: 206-730-0670
ROW Permit:
Yes
Customer Email:
Est. Start Date:
10/24/22
PM / Inspector:
Nayeli Torres -Garcia
Phone: (206) 556-5066
Est. Duration:
2 Days (16 Hours)
Site Contact Email:
GARY KLICK
Phone: 206-730-0670
Job Description
Project Scope: FROM 2" MPE MAIN ON 203RD ST SW, INSTALL APPROX. 126' OF 1-1/4" PE SVC (36'PLAT/90'SCAT) AND SET A250 VISA O/R New Construction:
ON FRONT HOUSE. FROM NEW SVC, INSTALL APPROX. 76' OF 1-1/4" PE PLAT TWIN SVC AND SET A250 VISA O/R ON BACK HOUSE. Yes
RESTORATION LIMITS TO BE DETERMINED
BY CITY ENGINEERING INSPECTOR
PLAT Map: 162.069
CM: KIRK SCHROEDER
425-736-7041
--——————————————— — — — — —— ........ ...... ..............................
€ €
SEWER — — — — — — — — — — — — — — — — — — — —— -- �.
EXISTING 2" MPE IP 16'N 107006790-1999 ......I ............... N Fli
i..........�.........
WATER
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.
PROPOSED 1-114" PE
SVC AND TWIN SVC
OWNER/CONTRACTOR IS RESPONSIBLE FOR -----`----- `----
EROSION CONTROL AND DRAINAGE
OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING
ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY
UTILITIES MAY REQUIRE A SEPERATE PERMIT.
7918
7922
Construction Method
Hole Hog
Building Foundation Type
Slab
Septic System
No
ENGINEERING DIVISION
"DTED
�J6j v 5/17/2023
_ _ _ _ _ _PA_RKIN_G SHOULDER _
It
N
V
V
2
C
rn
Work
Location
Size of Cut
Surface Type
16'
NORTH
I of CL
1203RD ST SW
&
914'
WEST
of CL
77TH AVE W
3 X 5 X 2
GRS
3'
NORTH
I of CL
1203RD ST SW
&
914'
WEST
of CL
177TH AVE W
3 X 3 X 2
A
Service Information
Street Information
Job Type
Diameter:
1-1/4" PE
Flaggers #:
0
Arterial:
No
New Residential Svc
EFV:
1-1/4" - 2600 - 9996744
Police #:
0
TCP:
Yes
Tie -In Fitting
Meter:
A250
A250
Speed Limit:
30
No Parks #:
6
MDPE - 2" IPS - (DIA) 1-1/4"IPS
9999548
Meter Loc:
08 - OR
Trolley Lines:
No
Mtr Hoods #:
0
Del Press:
6" W.C.
Traffic Signal:
I
Bus Stop:
No
SNO YRD - Snohomish Q
Bollards:
2.5" #
4" #
ADA Ramps #:1
0
Route #'s:
RECEIVED
May 04 2023
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING
ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY
UTILITIES MAY REQUIRE A SEPERATE PERMIT.
OWNER/CONTRACTOR IS RESPONSIBLE FOR
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.
W20-7A
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 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 11' 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 167 T NCL of 203RD ST SW & 914'
WCL of 77TH AVE W.
CREW SHALL POTHOLE
FOR WATER MAIN
DEPTH PRIOR TO
PROJECT START
co C�
co �J
r
50'
LEGEND
®
28" TRAFFIC CONE
®
WORK PIT
TRAFFIC FLOW
FLAGGER
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
Row
Row
TEMPORARY TRAFFIC CONTROL PLAN
7918
SIGN SPACING
MPH
I.K.
60/65
1000,
45/55
500'
35/40
350'
30
200'
25
100'
RESIDENT(S) WILL BE
INFORMED OF POSSIBLE
TEMPORARY DRIVEWAY
CLOSURE
0-0
W3-4
fi-0ZM
dL-•O■ZM
��-OZM
a
O� -¢=
Q
,00 E00
203RD ST SW
C=
RESTORATION LIMITS TO BE DETERMINED
BY CITY ENGINEERING INSPECTOR
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
U25/30
20
40
ENGINEERING DIVISION
"OTED
p(� 6yly 15/17/2022
RECEIVED
May 04 2023
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
Designer: PLAN PREPARED BY: REV
PUGET TRAFFIC MANAGEMENT, INC. 08/26/2022 0
SOUND John Crofoot 800.763.3999
ENERGY 425-424-6658 www.trafficmanagement.com Job #
Traffic Camel Services - Sales & Rentals
Permits & Canmlting Engineering Training
11*
TCP@PSE.COM TAAI 502656148
C31 # 785804
Project Address: TMI CONTACT PERSON: Michael Flanagan
TCS7918 203rd St, Edmonds, WA 98026 PLAN
ORDER:7 092 Page
PLAN ORDER: 74096 DATE: 8126122 1 OF 1