ENG2022-0447 ROW PERMITOF WAY PERMIT
PERMIT ER
City •EdmondsRIGHT
Edmonds•:0i i
www.edmondswa.gov i
Description: ROW IMPROVEMENTS FOR HERZER S.P. PLN2021-0034 ISSUED: 08/01/2023
Address: 16209 74TH PL W EDMONDS WA 98026
EXPIRES: 08/01/2024
Permit Type: RIGHT OF WAY Permit Subtype: SUBDIVISION Parcel Number: 00513100006600
NAME TYPE NAME ADDRESS PHONE
APPLICANT BRETT HERZER 16209 74TH PL W, EDMONDS WA 98026 (206)261-7676
CONTACT PUGET SOUND PLANNING, LLC 6100 219TH ST SW SUITE 480, MOUNTLAKE TERRACE WA (425)830-1046
98043
CONTRACTOR JB ASPHALT PAVING INC 22228 95TH PLW, EDMONDS WA 98026 (425)774-6537
OWNER BRETT H & CHERI M HERZER 16209 75TH PL W, EDMONDS WA 98026 (206)261-7676
FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $40.00
RIGHT OF WAY STANDARD PERMIT FEE $330.00 $330.00
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
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: 08/01/2023
Printed: Tuesday, August 01, 2023 5:18:38 PM 1 of 2
RIGHT OF WAY PERMIT
PERMIT '
City of • • .
121 Sth Ave N, Edmonds WA 98020 i i
www.edmondswa.govi
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
X-2 ENGINEERING FINAL"
A-1 TESC AND MOBILIZE
E-7 PVMT SUBGRADE
E-7 RESTOR LIMITS
E-7 TRAFFIC CTRL
E-7 PAVEMENT COMPACTION TEST
Compaction Test Report for Subgrade
REPORT
Printed: Tuesday, August 01, 2023 5:18:38 PM 2 of 2
Authentisign ID: 6124747C-402A-ED11-AE83-14CB655B2CA7
RECEIVED
I
'tof EDA404,,,
1NC. 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.
Sep 02 2022
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 Herzer Short Plat Right of Way
Site Address or if no site address use Property Address at NW corner of project area: 16209 74th PI W, Edmonds, WA 98026
Associated Permits: BLD PLN PLN2021-0034 FENG
• • • .• .• -
Name of Company Franchise Ordinance No:
Point of Contact
Title
Address
City
State
Zip
Phone
Email
Contractor and Authorized Agent of Owner (see note below)
Name of Company1. B. Asphalt Paving, Inc.
Contractor Contacts During Construction
Primary Name Bret Niebruegge
Agent Name Bret Niebruegge
Title President
Title President
Mobile (206) 714-3271
Address 22228 95th PI W
Email bret@jbasphalt.com
City Edmonds
State WA
Zip 98026
Secondary Name
Phone (206) 714-3271
Title
Email
bret@jbasphalt.com
Mobile
City of Edmonds Business License No: #13Ir006638
Email
State License No: JBASPBA872KI
® 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
Ni 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
Authentisign ID: 6124747C-402A-ED11-AE83-14CB655B2CA7
RECEIVED
❑ Utility Franchise Work (no associated development)
Sep 02 2022
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
ProjectDescription
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.)
Grading on the south side of 162nd St SW and asphalt widening to achieve an I F wide eastbound travel lane. Approximately 81 sf
of new asphalt. Two foot deep cut, trenching for new water service line and installation of a new water meter. Partial eastbound
lane closure for no more than 3 days. No walkways or alleys exist along the roadway.
RIGHT-OF-WAY
CLOSURE
AREA Aone
TOTAL
DURATION
(Number of Months)
Sidewalk 72 hours +
LF
JxJ
LF
None SF
0
Alley 72 hours +
LF
JxJ
LF
None SF
0
Parking 72 hours +
LF
JxJ
LF
None SF
0
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
CWT-WAY41i
❑ storm
Details
1.
of Work to be Completed
Does the utility owner have existin overhead infrastructure in the area of work?
Yes
No
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?
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
®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
Authentisign ID: 6124747C-402A-ED11-AE83-14CB655B2CA7
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:
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:
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 wjt�i e����Cq�,nditions listed on the Submittal
Requirements; with all applicable city ordinances, including but not limit C 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 alilepermit fees.
APPLICANT SIGNATURE:
r8ret DATE: Niehrueyye 09/01/22
APPLICANT PRINTED NAME: Bret Niebruegge
APPLICANT TITLE: Owner
RECEIVED
Sep 02 2022
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE CITY OF E
DEVELOPMENTT SERVI SERVICES
DEPARTMENT
City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021