BLD2023-0445+ROW APP-UPDATED+4.14.2023_10.17.10_AM+3483503-� RIGHT OF WAY CONSTRUCTION
PERMIT APPLICATION
Complete and submit this Application in accordance with the Submittal
"VC. 1594 Requirements outlined in Right,of-Way permit Handout Ems.
If any field is not applicable to your project, write "N/A' instead of leaving blank.
All fields required. Incomplete Applications will be denied.
SECTION A
Project Name Cline Jewelers Relocate TI
Site Address or if no site address use Property Address at D W corner of project area: 100 5th Ave. N. , Edmonds WA 98020
Associated Permits: SLD 2023_Q2gp PLN ENG 2023-0188
Name of Company Cline J ewe le rs Franchise Ordinance No:
Point of Contact Andv Cline
105 5th Ave South
Edmonds state WA zip 98020
206817-7979 -
an dy @ cli ne'ewelers.cvm
Name of Company MRJ Constructors Primary Name David Miller
Agent Name Gabe Dunla — Title Su erintendent
-rive Pro'eet Engineer _ Mobile 425 24$-5257
Address 1400 Alr ort Wa South Email dmiller@mr'constru
City17 State Zip Secondary NameGabe Dun
Phone .,- —^% � Ar ni n{ n TitlePrniprt Fnninppr
nmau dunla @ mr constructors.com ct�v a�+�-ua
City ofEdmands Business License Na:ra+ee Belflw Ema'sl dunla @ mr constructors.ca
State License No: M RJCOL*011 CW
Contractor verifies it is currently bonded 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
engineer.
IMe of Development - Ch�e_k_ ALL that apply
Multifamily residential X Commercial o City project
❑ Single family residential subdivision a Single family -other ❑ Industrial
o Demo and rebuild or from vacant land?
❑ Other, please specify:
❑ Utility Franchise Work associated with development check one of the above boxes as wet
❑ Traffic Control Only (no associated development)
City of Edmonds ROW construction permit Application --Page 1 of 3 Updated s/25/2021
❑ Utility Franchise Work (no associated development)
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
AREA
TOTAL
DURATION
CLOSURE
Irv; cola d1.cot •
Of17
(Number of Months)
G CC i0l�e I[..
5
Sidewalk 72 hours +
- LF x
_ -
- S
.30
Alley 2boom +
LF x
LF
SF
Pax1dng 72 hours +
LF x
.5 LF
SF
SECTION B - 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 o cable ❑ power o gas
❑ water D sewer ❑ storm
Yes
No
Details
1.
of Work to be Complet(,d
Does the utility owner have exist overhead infrastructure in the area of work?
z.
Will an equipment be added under ound or above ound (e.. edes[als, 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?
q.
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?
Does the work involve
proposed additions to an above ound utility system? If es:
Are the additions for the 2urpose of serving new commercial
development?
Are the additions for the purpose of serving a singie-tarmly
residential subdivision?
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 man am existin ? How manare 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 oles to be laced?
How man ? What is the hei tofthe additional oles?
6c.
1 Are any poles to be modified/rebuilt/replaced? If yes:
How many? 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 Uty regmalmns as
required by the City Engineer. Every flogger must be trained as required by WAG 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
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.
l
APPLICANT SIGNATURE: DATE: 04/05/2023 _ _
APPLICANT PRINTED NAME: Gahc r1i nlan
APPLICANT TITLE: Prnrrt Engineer
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
City of Edmonds ROW construction permit Application --Page 3 Of Updated 3/25/2021