ROW PERMIT APPLICATIONof t= LEA-10't'
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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 108620715
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871 C2
City Business License #: NR-019840
CONTACT: Megan Carabba
Phone #: 360-333-9461
Fax #:
Email #: megan.carabba@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 21705 96th Ave W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family X❑ Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSI,,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes 0 No
ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : Occupying the S bound lane of 96th Ave W
to, at 1-1/4" main cut and cap 5/8" PE and pull meter at 21705 96th Ave W. 1 (3x4) hard surface cut anticipated.
job #108620715
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year:108U
PAVEMENT CUT: ❑N Yes❑ No
CONCRETE CUT: ❑ Yes ❑ No
If yes, indicate size of cut: 3 x4
If yes, indicate size of cut: x
RIGHT-OF-WAY
AREA
CLOSURE
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF
X
LF
SF
Alley 72 Hrs + LF
X
LF
SF
Parking 72 Hrs + LF
X
LF
SF
APPLICANT TO READ AND SIGN
*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 is to 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.
Indemnity: The Applicant has signed an application which states he/she hold 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 defense costs and attorney fees by reason
of granting this permit.
I have read the above statements and understand the permit requirements and acknowledge that I must
follow all requirements in order for the
/fpermit to be valid.
SIGNATURE %� A�� DATE 2/17/2020
Contactor or Agent—""
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Job #:
Date:
Jurisdiction:
ROW Permit:
Est. Start Date:
Est. Duration:
108620715
2/11 /20
Edmonds
Yes
3/23/13
112 Day (4 Hours)
Puget Sound Energy Gas Pre -Inspect Form
Address:
City / Zip:
Customer:
PM / Inspector:
21705 96TH AVE W
BRIER, 98036
MIREL ROGOJAN
Kevin Williams 425-691-7573
Job Description / Scope of Work
At 1-1/4 main(inserted 2" st casing) C&C 5/8 PE (inserted 3/4 st casing) and pull meter
New Construction:
0
Construction Method
PLAT Map: 164.062
217th ST SW
t
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11.110-1961
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21701
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11 8 4 S °'
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5/8" AA P E I
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2005
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5/8„ AAPEI
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----- 2005
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21705
04
'S
60' R/W
61'S
21/0()
II
1
Work
Location
Size of Cut
Surface Type
15'
W
of CL
96th AVE W
&
107'
S
of CL
217th ST SW
3X4
Asphalt
of CL
&
of CL
of CL
&
of CL
Service Information
Street Information
Job Type
Diameter:
0
Flaggers #:
Arterial:
Cut & Cap
EFV:
0
Police #:
TCP:
Yes
Tie -In Fitting
Meter:
Speed Limit:
25
No Parks #:
Meter Loc:
0
Trolley Lines:
Mtr Hoods #:
Del Press:
6" W.C.
Traffic Signal:
Bus Stop:
Bollards:
2.5" #
1
1 4" #
I
ADA Ramps #:1
Route #'s:
Puget Sound Energy
Traffic Control Supervisor:
Gregory Harwood
Card No. 012238
Card Exp. 09/30/2023
gregory.harwood@pse.com
(425)424-6425
PRINT ON
11X17" SHEETS ONLY
TEMPORARY TRAFFIC CONTROL PLAN
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215TH PL SW o I Q
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216TH PL SW
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100'
100'
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CREW WILL USE ADA
COMPLIANT
RAMPS FOR PEDESTRIAN
DIVERSION
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 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 15' WCL of 96th Ave W & 10T SCL
of 217th St SW.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
SIGN SPACING
MPH
"XI.
60/65
1000,
45/55
500'
35/40
350'
30
200'
25
100'
MINIMUM TAPER LENGTH=L (FT.)
LANE
WIDTH
20
25
POSTED SPEED (MPH)
30 35 40 45 50
55 60 65 70
10
70
105
150
205
270
1475
1500
1550
1 -
-
-
11
75
115
165
225
295
495
550
605
660
-
-
12
80
125
180
245
320
540
600
660
720
78
8840
PUGET
SOUND
ENERGY
JOB# 108620715
o
21705 96th Ave E, Edmonds, WA 98020
2/12/2020
safaa.neema@pse.com
(425) 398-6077
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