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ENG2023-0250 ROW PERMIToff' EIDM o OF WAY EUC PERMIT �~ oCity of Edmonds PERMIT NUMRIGHT f Edmonds98020 1 1 1 www.edmondswa.gov i Description: ZIPLY - TRANSFER ATTACHMENTS AND REMOVE 1 BO POLE ISSUED: 06/12/2023 Address: 21224 84TH AVE W EDMONDS WA 98026-7300 EXPIRES: 12/12/2023 Permit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00613400000801 CONTACTS NAME TYPE NAME ADDRESS PHONE APPLICANT DONAVON LAFLEUR 180041ST ST. STE. N100, EVERETT WA 98203 (425)583-4057 CONTACT ZIPLY FIBER NORTHWEST LLC 180041ST ST. STE. N100, EVERETT WA 98203 (425)583-4057 CONTRACTOR ZIPLY FIBER 1800 41ST ST, EVERETT WA 98201 (425)949-0230 OWNER SACKETTJEFFREY C/SACKETT CARL W 21224 84TH AVE W, EDMONDS WA 98026-7300 FEE INFORMATION DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE - PER PERMIT $45.00 $45.00 ENG - INSPECTIONS $504.00 $504.00 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: 06/12/2023 Printed: Monday, June 12, 2023 1:55:56 PM 1 of 2 o RIGHT OF WAY EUC PERMIT f PERMIT NUM of Edmonds EdmondsCity 98020 1 1 1 www.edmondswa.gov i 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 COMPLETE A-1 JOB START E-7 TRAFFIC CTRL X-2 ENGINEERING FINAL" E-7 CONCRETE SIDEWALK E-7 CURB GUTTER E-7 RESTOR LIMITS Printed: Monday, June 12, 2023 1:55:56 PM 2 of 2 RECEIVED MAY 18 2023 Lti�y of EDh4fO4O� lNC. 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. 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 5518978-148 Site Address or if no site address use Property Address at NW corner of project area: 21224 84th Ave W 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 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: 91 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 TO PLACE (2) 5' ALLEY ARM, TRANSFER(1) ATTACHMENT, (10) DROPS, (1) BSW, 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 existin overhead infrastructure in the area of work? x • 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? X 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? 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? I I How many are to be added? 6b. Does your project involve poles? If yes: X How many poles are existing in the project area? a What is the height of the existing poles? 50' How many poles are to be removed? 1 Are additional poles to be laced? X How many? I I What is the height of the additionalpoles? 1 50' 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: 5/17/2023 APPLICANT PRINTED NAME: David Rodriguez 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 SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM LEGEND: EXISTING UTILITY POLE ® PROPOSED NEW POLE WORK DETAILS: PUD WILL PLACE NEW POLE, ZIPLY TO PLACE (2) 5' ALLEY ARM, TRANSFER (1) ATTACHMENT, (10) DROPS, (1) BSW, THEN REMOVE EXISTING POLE. Applicant shall repair/replace all OWNER/CONTRACTOR IS RESPONSIBLE FOR OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING damage to utilities or frontage EROSION CONTROL AND DRAINAGE ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY improvements in City right-of-way UTILITIES MAY REQUIRE A SEPERATE PERMIT. per city standards that is caused or occurs during the permitted project. N b RECEIVED MAY 18 2023 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT ziPy I fiber Everett, WA 98206 can 3 rn co z Z LO 2 N a Lu `6 O j Q w Q co 2 = H 0 P1/ Cb LL co 00 ,I-n N Y) LO N_ N �N 1� O U m W C) z Q Z O W Q O O U z w a a OJ LL DATE: 04.07.2023 DESIGNED BY: L.MATEO SCALE: SHEET: NOT TO O' SCALE NO: 1 OF 1 ENGINEERING DIVISION APPROVED AS NOTED Jell 06/09/2023 EPEE= TRANSFER OF UTILITIES, REMOVAL OF POLE AND FINAL RESTORATION TO BE CONSISTENT APPENDIX A WITH APPLICABLE POLE ATTACHMENT AGREEMENTJOINT POLE NOTIFICATION 2022 S) AND JOINT OWNERSHIP POLE AGREEMENT. Yeor Price List SW 12-5603 268292 8400 8404 840 SL-12 30- 406 15-9 2 5- 0 N 14439 NORTH i I F 25 D 107 24 LAYOUT NTS Q 00 1 J 45-65 Comcast CONSTRUCTION NOTES OA AT POLE PLI 14439 EXISTING 45' CLASS 2 POLE REMOVE EXISTING 15-9638 & 50-1700 OH TRANSFORMERS LITC#----------------------- SER#---------------------- LITC#----------------------- SER# ---------------------- SEC VOLT ----- /----- /------ SEC VOLT ----- /----- /------ INSTALL GRND PLATE ON A 50' CLS H4 POLE (NO110, PWH4050) SET POLE EXTRA DEEP (11') WITH 10" RAKE, 4' WEST OF EXIST POLE INSTALL 3PH ALLEY ARM ASSY W/ BRACELESS WINGARM (12F337) INTERCEPT EXISTING 3PH 336AAC OVERHEAD WIRES TRANSFER & ATTACH (SLACK SPAN) TO END OF ARM EXISTING 1PH OH LATERAL DUE EAST, TAP PH3 (12V115) INSTALL NEW CUTOUT ASSY AND FUSE 25A (E0204, E1025) INSTALL 7' BRACELESS WINGARM FOR NEUTRAL (X0551) INSTALL CLUSTER MNT BRACKET & ADAPT PLATE (R0303,R0304) INSTALL 15KVA (BA21L) & 50KVA (BA21R) 120/240V OH XFMRS LITC#----------------------- SER#---------------------- UTC#----------------------- SER# ---------------------- SEC VOLT ----- /----- /------ SEC VOLT ----- /----- /------ INSTALL NEW 12' STREETLIGHT MAST (1-0505) TRANSFER EXISTING SL LED LUMINAIRE (SL-128830-G) INSTALL NEW 3" SEC RISER (FO106) AND WEATHERHEAD TO EXISTING PEDESTAL (FO1303) TRANSFER EXISTING OVERHEAD 1PH & 3PH SERVICES REMOVE EXISTING 8' STREETLIGHT MAST STRIP AND TOP OLD POLE FOR COMMUNICATIONS RECEIVED MAY 18 2023 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT 1112 Rev. 10/20 To CATV: ZIPLY Exchange Date z_ ZIPLY COMCAST 2100 3/23/2023 wto Cn -t Customer Name Service Address o � o SNOPUD BO POLE 21224 84TH AVE W, EDMONDS WA 98026 � N PUD Order/Operation No. PUD Engineer PUD Approved z 0 v, 100107467-30 �RICHARD DUMO 425-783-5110 PUD INTENDS TO PERFORM THE FOLLOWING ON THIS WORK ORDER: out ❑ Set Poles ❑ Set Additional 8'' Helix Anchors 3/23/2023 ® Replace 1 Pole ❑ Set Additional 12'' Helix Anchors In ❑ Eliminate Poles From PUD System ❑ Customer Pay 1007 Contacts Free To ZIPLY ❑ PUD To Contact ZIPLY Pole(s) At Location(s) BM Number Other ZIPLY Pay 45Y Of The Following (Estimates Only) PUD Work Completed Easement Estimate ZIPLY Transfer Y CATV Transfer Y PUD is abandoning its use of each pole designated to be replaced or eliminated hereunder and is removing its attachments therefrom NOTE CITY OF EDMONDS IS REQUIRING THE INSTALLATION OF APPROVED ADA RAMP WHERE THE OLD POLE IS LOCATED AFTER IT 1S REMOVED. Crews are replacing the pole with a 50' wood Cls H4 pole Ziply: Place 2-5' alley arms. Transfer 1 attachment, 10 drops, 1 BSW. Remove pole. Flagging required. Return to Joint Use By 4/13/23 ZIPLY = 45% OF A 45' POLE YES FOR ZIPLY USE ONLY E]ZIPLY ACCEPTS THE FOLLOWING NO JOINT USE Pole/Location Reference � N 0 N ° E C a Size Recovery (Size/Year) Cost Pole/Location Reference Cn 0 I N ° .€ C D Size Recovery (Size/Year) Cost A X 45 (45-65) 2,878.77 Additional Anchors At The Following Locations WOO/USOA Codes Fielded By: Mark Perry Date: Apprave4i/By: rL /`'z 4, 3/29/23 Date: 3/27/23 J E 3 ATCO COMMUNICATIONS SERVICES, LLC AS THE DESIGNER OF THIS TRAFFIC CONTROL PLAN, 0AKES 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) -:) Teriyaki 19 Japanese . S Smith right Estates 9 214th Pr SV T Narnac te agIc.ii P p � _ CallvarvCan' el Eomorrf- Bar Dojo Asian , SS WORK AREA FG- Grow wii"1 Us Preschool and Child Care VICINITY MAP El 212th St SW Bel- - 7 •I, I' F,i I!• -17 9 SLt A I b, Episcc RECEIVED MAY 18 2023 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT JWAIFMVME ATCO COMMUNICATIONS SERVICES. LLC www.atcotelecom.com 360.563.9000 708 First Street Snohomish, WA 98290 ziPIy fiber Everett, WA 98206 ob 0') c U 00 0 E 0 E Ln -0 -Lu Lu Q 3: 3 N Q � ui a C 00 7 N E ' W W N N N ?) LLJ N N Q 2 � 00 V N N_ c1f N LLi a- 00 OOb U `2 Lu LO m � o Z U Q U z O w 2 Lu Lu H Q Z 0� O J_ d a. -I LL DATE: 5.11.2023 REVIEWED BY: K. BUXTON WSTCS# 013250 DESIGNED BY: D. RODRIGUEZ ATCO CONTACT: 714.651.2132 david.rodriguez@atcotelecom.com SCALE: SHEET: T T� 01 S� A E NO: 1 OF 2 LEGEND: SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM SU SIGNALIZED 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 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) SIGN LEGEND: ROAD SHOULDER WORK WORK AHEAD W20-1 W21-5 ANY RK AFFECTING TRANSIT OPERATIONS ❑❑R FACILITIES CONTACT CIC 21224 @ 206-477-1140 PR❑VIDE ONE WEEK N❑TIFICAI❑N FOR BUS STOP IMPACTS FLAGGERS WILL HAVE WORK STOP TO ESCORT PEDESTRIANS THROUGH W❑RKZ❑NE I D/W SIDEWALK BUS O a a -- a 1 D/W 84TH AVE W (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' WORK DETAILS: PUD WILL PLACE NEW POLE, ZIPLY TO PLACE (2) 5' ALLEY ARM, TRANSFER(1) ATTACHMENT, (10) DROPS, (1) BSW, THEN REMOVE EXISTING P❑LE, SPOTTER NEEDED FOR PEDESTRIAN TRAFFIC AND DRIVEWAY ACCESS. MERGE BIKE CLOS W21- TRAFFIC CONTROL INSPECTION SHALL BE REQUIRED WHENEVER WORK ZONE IS SET UP NOTE: MON. - FRI. = 7:00am TO 4:00pm CHANNELIZATION DEVICE SPACING (feet) MPH TAPER I TANGENT 50/70 40 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' PHASE 1 a z ENGINEERING DIVISION APPROVED AS NOTED ,l1/ (VZ,, jo,44.g 06/09/2023 VV 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 v ao vi a u 0 00 Lo o w o w U) ui I) o Q I_o 00 N W 0 N > N 1z < I— v 00 N z 04 N O Z Ua 00 U 00 ao C w U.1 L0 LL u' m � 0 o z U < U z O c w ILL! ILL! Z of � U O LLI D- D- LL DATE: 5.11.2023 REVIEWED BY: K. BUXTON WSTCS# 013250 DESIGNED BY: D. RODRIGUEZ ATCO CONTACT: 714.651.2132 david.rodriguez®atcotelecom.com SCALE: SHEET: =5C 02 NO: 2OF2 RECEIVED CITY OF EDMONDS Right -of -Way Application #1317372 - 5518978-148 MAY 18 2023 MyBuildingPermit.com CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT Applicant First Name Last Name Company Name Donavon Lafleur Ziply Fiber Northwest LLC Number Street Apartment or Suite Number E-mail Address 1800 41st St. Ste. N100 Ste N-100 Donavon.lafleur@ziply.com City State Zip Phone Number Extension Everett Wa 98203 (425) 583-4057 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 City Zip Code County Parcel Number Associated Building Permit Number Tenant Name Additional Information (i.e. equipment location or special instructions)_ Work Location 21224 84th Ave W Edmonds, WA Property Owner First Name Last Name or Company Name Number Street Apartment or Suite Number City State Zip 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: 5/17/2023 Submitted By: Donavon Lafleur Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Right -of -Way Application #1317372 - 5518978-148 Project Contact Company Name: Ziply Fiber Northwest LLC Name: Donavon Lafleur Email: Donavon.lafleur@ziply.com Address: 1800 41st St. Ste. N100 Ste Phone #: (425) 583-4057 N-100 Everett Washington 98203 Project Type Utility Purveyor Activity Type Utility Work Scope of Work Disturbance of Surface Project Name: 5518978-148 Description of Work: PUD WILL PLACE NEW POLE, ZIPLY TO PLACE (2) 5- ALLEY ARM, TRANSFER(1) ATTACHMENT, (10) DROPS, (1) BSW, THEN REMOVE EXISTING POLE. Project Details Project Information Job Number 5518978-148 Page 2 of 2