ENG2023-0493 ROW PERMITRIGHT OF WAY EUC PERMIT
PERMIT NUMBER
City of Edmonds
:004•
www.edmondswa.gov i
Description: PSE - CUT OUT COUPLER AND INSTALL 20LB ANODE ISSUED: 11/09/2023
Address: 10310 240TH PL SW EDMONDS WA 98020-5741
EXPIRES: 05/09/2024
it Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00565000000902
W
NAME TYPE NAME ADDRESS PHONE
APPLICANT SUSAN SIDICK 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353
CONTACT PUGET SOUND ENERGY 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353
CONTRACTOR PSE/INFRASOURCE 1660 PARK LANE, BURLINGTON WA 98233 (425)466-4771
OWNER MICHAEL JEROME & HANN JENSEN 10310 240TH PL SW, EDMONDS WA 98020
FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE - PER PERMIT
$45.00 $45.00
ENG - INSPECTIONS
$252.00 $252.00
RIGHT-OF-WAY PERMIT - STANDARD $378.00 $378.00
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: 11/09/2023
Printed: Thursday, November 09, 2023 2:50:32 PM 1 of 2
RIGHT OF WAY EUC PERMIT
PERMIT NUMBE3
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
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, November 09, 2023 2:50:32 PM 2 of 2
of EpM041.�
RECEIVED
RIGHT OF WAY CONSTRUCTION SEP 29 2023
PERMIT APPLICATION
CITY OF EDMONDS
Complete and submit this Application in accordance with the Submittal DEVELOPMENT
/'Vc. is') Requirements outlined in Right -of -Way permit Handout E6�. 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.
SECTION A
General •
Project Name 109150854
Site Address or if no site address use Property Address at NW corner of project area: 10310 240 PL SW
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
d( 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 ix 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 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.)
*COMPLIANCE* 170' ECL 24oTH PL SW AND 3' NCL OF 24oTH PL PRIOR TO JOB START. DIG UP 2" STW
MAIN AT LOC BY PASS: CUT OUT DRESSER COUPLER INSTALL 2oLB ANODE WITH TEST LEAD. INSTALL
20 LB ANODE ON 3/4" STW (1) 2x7 paving cut anitcipate
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 +
I LF
Ix
I LF
I SF
1 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 3xgas
❑ 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: 09/28/23
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 #: 109150854
Service Address:
Date:
City
Jurisdiction:
Customer:
ROW Permit:
Customer Email:
Est. Start Date:
PM / Inspector:
Est. Duration: B Hours
Site Contact Email:
10310 240TH PL SW
Michael Sweet
EDMONDS, Zip: 99020
Phone:
Phone:
Phone: 360-722-6752
Job Description
Project Scope: *COMPLIANCE* 170' ECL 240TH PL SW AND 3' NCL OF 240TH PL CALL JOHN
New construction:
No
ROCKFORD 206-255-2704 PRIOR TO JOB START. DIG UP 2" STW MAIN AT LOC BY PASS:
CUT OUT
construction Method
DRESSER COUPLER INSTALL 20LB ANODE WITH TEST LEAD. INSTALL 20 LB ANODE
ON 3/4" STW
SERVICE TO 10310 240TH PL SW.
Building Foundation Type
Septic System
PLAT Map: 167.066
t
N
RESTORATION LIMITS TO BE DETERMINED
BY CITY ENGINEERING INSPECTOR
ENGINEERING DIVISION
10308
"OTED
1/01/2022
PL PL -
X X /
H2016' NCL .0
10310
ASPHALT
0' 40'RADIUS X.
ROW 1"STW
240TH PL SW _ Is so N� DRIVEWAY 1-1/4" MPE ASPHALT
EXISTING3/4"STW
22' R
1-114" MPE X
22'SCL PL
X
L
Applicant shall repair/replace all
10312
damage to utilities or frontage
improvements in City right-of-way
per city standards that is caused or
occurs during the permitted project.
OWNER/CONTRACTOR
RESPONSIBLE FOR LOCATING
OWNER/CONTRACTOR IS RESPONSIBLE FOR ALL ON SITE UTILITIES.
RELOCATION/REVISION TO ANY
EROSION CONTROL AND DRAINAGE UTILITIES MAY REQUIRE
A SEPERATE PERMIT.
Work Location
Size of Cut
Surface Type
3'
North
I OFCL
1240TH PL SW
&
170'
East
I of CL
1104TH AVE W
2 X 7 X 3
A
Service Information
Street Information
Job Type
Diameter:
0
Flaggers #:
0
Arterial:
No
EFV:
0
Police #:
0
TCP:
No
Tie -In Fitting
Meter:
0
Speed Limit:
0
No Parks #:
0
Meter Loc:
0
Trolley Lines:
No
Mtr Hoods #:
0
Del Press:
Traffic Signal:
Bus Stop:
No
Bollards:
ADA Ramps #:
0
Route #'s:
RECEIVED
SEP 29 2023
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
TEMPORARY TRAFFIC CONTROL PLAN
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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 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 10' for
traveling lane width.
6. Alert affected residents and businesses.
7. Work to take place during approved work hours.
(Generally between 9 a.m. and 4 p.m. on
non -arterials and from 9 a.m. to 3 p.m. on arterials.
If night time work is approved, Night time work to take
place between and )
8. Work area will be Work area will be T NCL of 240Th PI
SW & 170' ECL of 104Th Ave W.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
M
102ND AVE W
240TH PL SW
N
4 oa 70
0�IdSNIONI2] i
aANIMEA1 AI4 A9 Ol SlIW
d�ti ,FdMd M�.
CZOZ/104 al__ t /"
431G, I —
NOISIAIa 91\1121�]3NIONA
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1 OIIV2 ois]I2A
1 CO)
6 �p
DEAD END
MINIMUM TAPER LENGTH=L (FT.)
LANE
WIDTH
20
25
POSTED SPEED (MPH)
30 35 40 45 50
55 60 65 70
10
70
105
150
205
270
475
500
550
-
-
-
11
75
115
165
225
295
495
550
605
660
-
-
12
80
125
180
245
320
540
600
660
720
780
840
RESIDENT(S) WILL BE INFORMED OF
TEMPORARY DRIVEWAY CLOSURE
10310 240th PI SW
Edmonds
WA 98020
USA
SIGN SPACING
MPH
'X1
60/65
1000,
45/55
500'
35/40
350'
30
200'
25
100,
PUGET Designer:
SOUND Qyumin Parungao
ENERGY 425-424-6658
gyumin parungao@pse corn
Project Address:
10310 240th PI SW, Edmonds, WA, 98020
RECEIVED
SEP 29 2023
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
LEGEND
®
WORK PIT
®
28" TRAFFIC CONE
TRAFFIC FLOW
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
Row
WORK AREA
OCHEVRON
ARROW BOARD
ill
UNIFORMED
POLICE OFFICER
FLAGGER
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
Puget Sound Energy
Traffic Control Supervisor:
REV
Stephen R Gadke
Card No. 012922
09/05/2023
0
Card Exp. 131/2025
Stepher.Gadke@pse.com
Job #
(426)424-6431
,11114A c_
11953032
1 OF 1
RECEIVED
SEP 29 2023
CITY OF EDMONDS
Right -of -Way Application #1382517 - 109150854
MyBuildingPerriit
com
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
Applicant
First Name Last Name Company Name
Susan Sidick Puget Sound Energy
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 (425) 457-6353
State License Number License Expiration Date UBI # E-mail Address
PUGETSE032J 1 3/20/2024 179n 1 M55 susan.sidick@pse.com
Project Location
Number Street Floor Number Suite or Room Number
10310 240TH PL SW
City Zip Code County Parcel Number
EDMONDS 98020 00565000000902
Associated Building Permit Number Tenant Name
109150854
Additional Information (i.e. equipment location or special instructions)_
Work Location
Property Owner
First Name Last Name or Company Name
Michael Jerome & Hannah Rae Ttee Jensen
Number Street Apartment or Suite Number
10310 240TH PL SW
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: 9/28/2023 Submitted By: Susan Sidick
Page 1 of 2
CITY OF EDMONDS MyBuildingPermit.com
Right -of -Way Application #1382517 - 109150854
Project Contact
Company Name: Puget Sound Energy
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: 109150854
*COMPLIANCE* 170' ECL 240TH PL SW AND 3' NCL OF 240TH PL PRIOR TO JOB
Description of START. DIG UP 2" STW MAIN AT LOC BY PASS: CUT OUT DRESSER COUPLER
Work: INSTALL 20LB ANODE WITH TEST LEAD. INSTALL 20 LB ANODE ON 3/4" STW (1) 2x7
paving cut anitcipated
Project Details
Project Information
Job Number
109150854
Page 2 of 2