ENG2022-0320 ROW PERMITRIGHT OF WAY EUC PERMIT
PERMIT NUMBER
City of Edmonds
Edmonds WA 98020 ENG2022-0320
www.edmondswa.gov i
Description: PSE-REPLACE GAS SERVICE AND CUT AND CAP OLD SERVICE
ISSUED: 09/28/2023
Address: 535 FIR PL EDMONDS WA 98020-4647
EXPIRES: 03/28/2024
Permit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00536000000400
NAME TYPE NAME ADDRESS PHONE
APPLICANT SUSAN SIDICK 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353
CONTACT PUGET SOUND ENERGY- CORROSION 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353
DEPARTMENT
CONTRACTOR PSE/INFRASOURCE 1660 PARK LANE, BURLINGTON WA 98233 (425)516-4388
OWNER RICHARD L SCHAEFER 535 FIR PL, EDMONDS WA 98020
FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE CHARGED PER PERMIT
$40.00
$40.00
ENGINEERING INSPECTION FEE
$220.00
$220.00
ENGINEERING REVIEW FEE - OVER 3 REVIEWS
$110.00
$110.00
RIGHT OF WAY STANDARD - EUC PERMIT FEE
$330.00
$330.00
STREET OVERLAY CUT - PENALTY FEE $475.00 $475.00
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: 09/28/2023
Printed: Thursday, September 28, 2023 1:07:06 PM 1 of 2
RIGHT OF WAY EUC PERMIT
PERMIT NUMBE3
City of Edmonds
,...Ave
N, Edmonds WA 9:01 1 1
www.edmondswa.gov • •
CONDITIONS
CONDITION TYPE
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:OOam to 6:OOpm on
SOUND AND NOISE
weekdays and 10:OOam and 6:OOpm 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
X-2 ENGINEERING FINAL**
E-7 RESTOR LIMITS
Printed: Thursday, September 28, 2023 1:07:06 PM 2 of 2
RECEIVED
of EpM04O�
/'Vc. i Ba 3
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�.
J U N 27 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 •
Project Name io9i43o36
Site Address or if no site address use Property Address at NW corner of project area: 535 Fir Place
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
E* 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 ❑dingle 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.)
replace gas service and cut and cap old gas service at approx 17' S c/l of Fir PI W & S's c/l of Fir PI W also 2o6'w to
210' W CA of 6th AVE S (1) 4x8 paving cut (2),us paving cuts 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 ❑Ngas
❑ 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: o6/20/22
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
Job #:
Date:
Jurisdiction:
ROW Permit:
Est. Start Date:
Est. Duration:
109143036
Edmonds
Puget Sound Energy Gas Pre -Inspect Form
Service Address:
City td mon ds Zip: 98020
Customer: Rick Schaefer Phone: 206-335-7428
Customer Email: text OK
PM / Inspector: Tanya Martinson Phone:
Site Contact Email: Mitchell Goetz Phone:
Job Description
Install 2 test leads at main with (2) 20# anodes, call John Rockford 2 days
New Construction:
No
prior to work starting. Replace 1/2" STW tripple service with 1-1/8" single
Construction Method
svc and a 1-1/8" twin service. IFS TO VERIFY CLEAR PATH FOR HOLE HOG
Hole Hog
OT BORE SVC PRIOR TO JOB START
Building Foundation Type
N/A
Septic System
PLAT Map: 164.000
RESTORATION LIMITS TO BE DETERMINED N
OVERHEAD POWER &COM BY CITY ENGINEERING INSPECTOR
T-CUT PATCHES THEN MINIMUM 20-FOOT
GRIND AND OVERLAY REQUIRED. ENGINEERING DIVISION
"DTED
IF T-CUTS ARE LARGER THAN (1) 5' BY 9' AND
dJ� 19/19/2023
_
(1) 4' BY 6', ADDITIONAL CUT FEES WILL BE !
ASSESSED.
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,
Dr
C/)
LU
FIR PL W
--
1 1 _ i WATER MAIN 5'S
-_J_
1 1
I I
I I
- —--------------
OWNER/CONTRACTOR IS RESPONSIBLE FOR RES U B
EROSION CONTROL AND DRAINAGE
Applicant shall repair/replace all Sep 14 2023
damage to utilities or frontage CITY OF EDMONDS
OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING improvements in City right-of-way DEVELOPMENT SERVICES
per is caused or
DEPARTMENT
ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY occurs durstaing
occurs during the permitted project.
the per
UTILITIES MAY REQUIRE A SEPERATE PERMIT.
Work
Location
Size of Cut
Surface Type
17'
of CL
FIRPLW
&
206'
W
of CL
6TH AVE S
4 X 8 X
A
5'
S
ofCL
FIRPLW
&
210'
W
ofCL
6THAVE S
3 X 5 X
A
5'
ofCL
FIRPLW
&
210'
W
ofCL
6THAVE S
3 X 5 X
A
Service Information
Street Information
Job Type
Diameter:
1/2" & 11/8"
Flaggers #:
1
Arterial:
No
Res twin extension
EFV:
2600
Police #:
0
TCP:
No
Tie -In Fitting
Meter:
250
Speed Limit:
25
No Parks #:
0
Meter Loc:
0
Trolley Lines:
No
Mtr Hoods #:
0
Del Press:
Traffic Signal:
Bus Stop:
®„��.
Bollards:
2.5" #
4" #
ADA Ramps #:
I Route #'s:
RESUB
SEPT 13 2023
CUT DIMENSIONS ESTIMATE 109143036
CITY OF EDMONDS
Prepared per city of Edmonds permit request for service replacements. DEVELOPMENT
p p y p q p SERVICES DEPARTMENT
Cut: Yes No
Surface #Cuts:
Type: *H *S (+)
Dimensions:
*W x *L x *D = Cu Ft
A
l
1
4'
8'
3
9 6
A
2
2
3'
5'
3
45
* J
0
0
* J
0
0
* J
0
0
* J
0
0
* J
0
0
* J
0
0
* J
0
0
* J
0
0
* J
0
0
* J
0
0
Total Cuts: 3 0 3 C u Ft. 141
Restoration needed? Yes No
T-CUT PATCHES THEN MINIMUM 20-FOOT
GRIND AND OVERLAY REQUIRED.
IF T-CUTS ARE LARGER THAN (1) 5' BY 9' AND
(1) 4' BY 6', ADDITIONAL CUT FEES WILL BE
ASSESSED.
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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 17' SCL Fir PI W & 206' WCL 6th
Ave S, 5' SCL Fir PI W & 210' WCL 6th Ave S, 5' SCL Fir
PIW&210'WCL6th Ave S.
TEMPORARY TRAFFIC CONTROL PLAN
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431C, . — ...
NOISlnl4 ONI J33NION3
s'
a0 17
a
m
a0 =
LEGEND
®
28" TRAFFIC CONE
®
WORK PIT
TRAFFIC FLOW
FLAGGER
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
ROW
SIGN SPACING
MPH
"X"
60/65
1000,
45/55
500'
35/40
350'
30
200'
25
1 100'
V-OZM
W-MM 0:az�00<1
�■
--------------- 100' 1 7100'-1+ 100'-
�-OZM
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•
•
FIR PL
Poi
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I
I
i
RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
I
I
I
I
I
I
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
LO G J
Ln
-----------------------
FIR ST
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RECEIVED
JUN 27 2022
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
Puget Sound Energy REV
PUGET Designer: T}affoControl Supervisor: Gregory Ha06/14/2022 0
SOUND Prachi Joshi rwood
Card No. 012238
ENERGY 425-354-8457 CardE.pham od@p3 Job #
gregory.phamood@pse.com
prachi.joshi@pse.com (425)424-6425 11868207
Project Address:
35 Fir PI Edmonds Page 1 OF 1
RECEIVED
JUN 27 2022
CITY OF EDMONDS
Right -of -Way Application #1161481 - 10914336
MyBuildingPermit.com
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
Applicant
First Name Last Name Company Name
Susan Sidick Puget Sound Energy- Corrosion Department
Number Street Apartment or Suite Number E-mail Address
1660 Park Lane susan.sidick@pse.com
City State Zip Phone Number Extension
Burlington WA 98233 (425) 457-6353
Contractor
Company Name
PUGET SOUND ENERGY INC
Number Street Apartment or Suite Number
1660 Park Lane
City State Zip Phone Number Extension
Burlington WA 98233 (206) 716-2641
State License Number License Expiration Date UBI # E-mail Address
PUGETSE032J 1 3/20/2024 17qn 1 M55 susan.sidick@pse.com
Project Location
Number Street Floor Number Suite or Room Number
535 FIR PL
City Zip Code County Parcel Number
EDMONDS 98020 00536000000400
Associated Building Permit Number Tenant Name
Additional Information (i.e. equipment location or special instructions)_
Work Location
Property Owner
First Name Last Name or Company Name
Richard L Schaefer
Number Street Apartment or Suite Number
535 FIR PL
City State Zip
EDMONDS WA 98020
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: 6/20/2022 Submitted By: Susan Sidick
Page 1 of 2
CITY OF EDMONDS MyBuildingPermit.com
Right -of -Way Application #1161481 - 10914336
Project Contact
Company Name: Puget Sound Energy- Corrosion
Department
Name: Susan Sidick Email: susan.sidick@pse.com
Address: 1660 Park Lane Phone #: (425) 457-6353
Burlington WA 98233
Project Type Activity Type Scope of Work
Utility Purveyor Utility Work Disturbance of Surface
Project Name: 10914336
Description of replace gas service and cut and cap old gas service at approx 17' S c/I of Fir PI W & 5's c/I
Work: of Fir PI W also 206'w to 210' W c/I of 6th AVE S (1) 4x8 paving cut (2) 3x5 paving cuts
anticipated
Project Details
Project Information
Job Number
109143036
Page 2 of 2