ENG2023-0452 ROW PERMITOF WAY MINOR PERMIT
PERMIT ER
City •EdmondsRIGHT
Edmonds98020 ENG2023-045
www.edmondswa.gov i
Description: ROW -STAGING DUMPSTER FOR SIDING PROJECT ON SFR ISSUED: 10/06/2023
Address: 802 MAIN ST EDMONDS WA 98020-3034
EXPIRES: 04/03/2024
Permit Type: RIGHTOF WAY MINOR Permit Subtype: RESIDENTIAL Parcel Number: 00434207700101
NAME TYPE NAME ADDRESS PHONE
APPLICANT CASSANDRA TARTABULL 14724 BOTHELL WAY NE, SEATTLE WA 98155 (206)887-9405
CONTACT PACIFIC EXTERIORS LLC 14724 BOTHELL WAY NE, SEATTLE WA 98155 (206)887-9405
CONTRACTOR PACIFIC EXTERIORS LLC 14724 BOTHELL WAY NE, LAKE FOREST PARK WA 98155 (425)319-7839
OWNER JEAN GILMORE PO BOX 3082, EDM0NDS WA 98020
FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE - PER PERMIT
$45.00 $45.00
RIGHT OF WAY DISRUPTION FEE
$323.35 $323.35
RIGHT-OF-WAY PERMIT -MINOR $126.00 $126.00
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: GRN DATE: 10/06/2023
Printed: Friday, October 06, 2023 5:24:41 PM 1 of 2
RIGHT OF WAY MINOR PERMIT
L
PERMIT NUMBE
City of Edmonds
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
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
X-2 ENGINEERING FINAL"
Printed: Friday, October 06, 2023 5:24:41 PM 2 of 2
RECEIVED
.1 of EVA40
G d•
INC. 1690
SECTION A
RIGHT OF WAY CONSTRUCTION
PERMIT APPLICATION
Complete and submit this Application in accordance with the Submittal
Requirements outlined in _% 1' J•
AUG 29 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 (� ` Z ' I �V►0 r�
Site Address or if no site address use Property Address at NW corner of project area: 0Z AlAl h �, O ! h Ayc S
Associated Permits: BLD PL V ENG
Owner and Entity Holding
Name of Company Franchise Ordinance No:
Point of Contact kA
Title
Address A
City State Zip
Phone
Email
ContractorandAuthorized
Name of Company l a
1
Agent of Owner (see
Ors
note below)
`/•
V
Contractor Contacts During Construction
Primary Name
�n Oo
Agent Name
A a�,
«
Title Y-
Title V
rn A
e
Mobile 7
Address -m
'I WO
N F
Email V
City SWa 16
State WA
I Zip
S5
Secondary Name
Phone
Title
Email CA4
aGl
'„' or 1
jrewi
Mobile
City of Edmonds Business Li nse No:
_ 02.bnf
Email
State License No:
L q 1-7 Nk
Contractor verifies it is currently bonded
A Contractor verifies it currently has general liability insurance
NOTE: ECDC i8.6o.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 KSingle family -other o Industrial
❑ Demo and rebuild or from vacant land?
❑ Other, please specify: s i'9it, 4M, ly h,0 n't
❑ 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 t of 3 Updated 3/25/2021
o"
❑ Utility Franchise Work (no associated development)
DescriptionProject
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.)
RIGHT-OF-WAY
CLOSURE
AREA
TOTAL
DURATION
(Number of Months)
Sidewalk 72 hours +
LF
x
LF
SF
Alley 72 hours +
LF
x
LF
SF
Parking 72 hours +
LF
x
LF
SF
p�
SECTION S - If you are not a utility company performing work in the City ROW, skip to SECTIONC.
1. The work in the right of way is on or for the following type of facilities:
❑ telecommunications ❑ cable power ❑ gas
❑ water ❑ sewer storm
Details of Work to be Completed
Does the utilitv owner have existing 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 �,es 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 stem?
5.
Does the work involve proposed additions to an aboveground utility system? If yes:
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 Work to be Completed Yes NO
6. 1 Does your project involve rebuilding or replacing utility equipment which currently serves more 77
than one lot or commercial development?
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
roject is proposed:
6a.
Does your project involve wires/cables/lines? If yes:
How mans, are existing? I i How mangy• are to be added?
6b.
I Does your project involve poles? If yes:
How mane 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 placed?
How many? I I What is the height of the additional poles?
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 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 fo 11 permit fees.
APPLICANT SIGNATURE: DATE: Z 2 z
APPLICANT PRINTED NAME: r' a
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
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ENGINEERING DIVISION
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0/06/2023
ACTOR IS RESPONSIBLE FOR -
COj TROL AND D Al GE I
l
RESP IBLE FOR LOCATING
RELOCATION/REVISION 1�0 ANY
REQUIRE A-SEPERATE P =
—
ER SIOfJ
— OWNER/CONTRACTOR
ALL ON SITE UTILITIES.
UTILITIES -MAY
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Applicant all repaidreplace
dama
improveme is in
per city Stan ards
occurs during
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ity right-of-w y
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2U23�—
AUG 29
CITY OF EDMONDS
j�
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1 DEVELOPMENT _
DEPARTMENT
!SERVICES
I
RECEIVED
CITY OF EDMONDS
Right -of -Way Application #1366692 - 9762: Gilmore
MyBuildingPermi1:.coM'UG 29 2023
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
Applicant
First Name Last Name Company Name
Cassandra Tartabull Pacific Exteriors LLC
Number Street Apartment or Suite Number E-mail Address
14724 Bothell Way NE cassandra@pacificexteriorsllc.com
City State Zip Phone Number Extension
Seattle WA 98155 (206) 887-9405
Contractor
Company Name
Pacific Exteriors LLC
Number Street Apartment or Suite Number
14724 Bothell Way NE
City State Zip Phone Number Extension
Lake Forest Park WA 98155 (425) 319-7839 (206) 877-7518
State License Number License Expiration Date UBI # E-mail Address
PACIFEL917NK 3/27/2025 Rn9Rs91 iq cassandra@pacificexteriorsllc.com
Project Location
Number Street Floor Number Suite or Room Number
802 MAIN ST
City Zip Code County Parcel Number
EDMONDS 98020 00434207700101
Associated Building Permit Number Tenant Name
9762: Gilmore
Additional Information (i.e. equipment location or special instructions)_
Work Location
Property Owner
First Name Last Name or Company Name
Jean Gilmore
Number Street Apartment or Suite Number
PO BOX 3082
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: 8/29/2023 Submitted By: Cassandra Tartabull
Page 1 of 2
i
CITY OF EDMONDS MyBuildingPermit.com
Right -of -Way Application #1366692 - 9762: Gilmore
Project Contact
Company Name: Pacific Exteriors LLC
Name: Cassandra Tartabull Email: cassandra@pacificexteriorsllc.com
Address: 14724 Bothell Way NE Phone #: (206) 887-9405
Seattle WA 98155
Project Type Activity Type Scope of Work
Single Family Residential Street Use Objects Temporary in Nature
Project Name: 9762: Gilmore
We need to stage the portable toilet and dumpster on 8th ave s for a siding
Description of Work:
project.
Project Details
Project Start
Proposed start date 8/29/2023
Project End
Proposed end date 9/7/2023
Page 2 of 2