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ENG2023-0626 ROW PERMITRIGHT OF WAY EUC PERMIT PERMIT NUMJBER City of Edmonds - N, Edmonds WA 98020 ENG2023-0626 www.edmondswa.govi Description: PSE - HYDROMAX TO TV SEWER LINES FOR CROSS BORES ISSUED: 01/04/2024 Address: 9703 241ST PL SW EDMONDS WA 98020-6512 EXPIRES: 07/04/2024 Permit Type: RIGHT OF WAY EUC Permit Subtype: MINOR Parcel Number: 00450200000200 NAME TYPE NAME ADDRESS PHONE APPLICANT JAIMEE FORMAN 6500 URSULA PL S, SEATTLE WA 98108 (206)702-8382 CONTACT HYDROMAX USA, LLC 6500 URSULA PL S, SEATTLE WA 98108 (206)702-8382 CONTRACTOR HYDROMAX USA LLC 6500 URSULA PL S, SEATTLE WA 98108 (502)851-6513 OWNER RONALD L & ALICE M TERREL 9703 241ST PL SW, EDMONDS WA 98020 FEE INFORMATION DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE - PER PERMIT $45.00 $45.00 ENG - INSPECTIONS $378.00 $378.00 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: MAJ DATE: 01/04/2024 Printed: Thursday, January 04, 2024 4:00:38 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 E-7 TRAFFIC CTRL X-2 ENGINEERING FINAL** Printed: Thursday, January 04, 2024 4:00:38 PM 2 of 2 RECEIVED DEC 08 2023 Lti�y of Epiy04o� lNC. 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. 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 CCTV Sewer inspections for PSE's Cross Bore Safety Program. Site Address or if no site address use Property Address at NW corner of project area: City wide, Please see attached list Associated Permits: BLD PLN ENG • applicable) Name of Company PSE/Hydromax USA Franchise Ordinance No: Point of Contact Jaimee Forman Title Municipal Liaison Manager Address 6500 Ursula PI S city Seattle state WA zip 98108 Phone 206-702-8382 Email jaimee.forman@hydromaxusa.com Contractor and Authorized Agent of Owner (see note below) NameofCompany Hydromax USA Contractor Contacts During Construction Primary Name N/A Agent Name Jaimee Forman Title Title Municipal Liaison Manager Mobile Address 6500 Ursula PI S Email City Seattle IState WA Zip 98108 Secondary Name Phone 206-702-8382 Title Email jaimee.forman@hydromaxusa.com Mobile City of Edmonds Business License No: #N R-026397 Email State License No: 603 250 097 IN Contractor verifies it is currently bonded Contractor verifies it currently has general liability insurance 1VU1h: 1 CDC 18.60.020 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 ❑ Single family -other ❑ Industrial ❑ Demo and rebuild or from vacant land? x 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 N Utility Franchise Work (no associated development) Project Description 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.) CCTV Sewer Inspections for PSE's Cross Bore Safety Program. Non-invasive annual routine maintenance. 30-90 minutes per location RIGHT-OF-WAY CLOSURE AREA TOTAL DURATION (Number of Months) Sidewalk 72 hours + LF JxJ LF SF Alley 72 hours + LF JxJ F SF Parking 72 hours + LF JxJ LF SF 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 ❑ sewer ❑ storm 1. CompletedDetails of Work to be Does the utility owner have existin overhead infrastructure in the area of work? • 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 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? 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: (I- DATE: 12.7.23 APPLICANT PRINTED NAME: Jaimee Forman APPLICANT TITLE: Municipal Liaison Manager NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM LEGENDS ..No CHANNELIZING DEVICE N ADVANCE WARNING SIGN LOCATION ® WORK VEHICLE x W20-1 MINIMUM TAPER LENGTH = L LANE WIDTH (FEET) 10 11 12 POSTED SPEED (MPH) 25 30 35 40 105 150 205 270 115 165 225 295 125 180 245 320 28" TRAFFIC CONES T-39 NOTE: 1. (NO PARKING) SIGNS IN PLACE AT LEAST 48 HOURS IN ADVANCE WITH DATE & TIME CLEARLY POSTED AND NOT OBSTRUCTING PARKING ACCESS UNTIL THE SPECIFIED DATE & TIME. HYDROMAX USA WORK ACTIVITY IN PARKING AREA RESIDENTIAL WARNING SIGN SPACING = X 35-40 MPH 350'+/- 350'+/- 1 350'+/- 25 30 MPH 200'+/- 200'+/- 200'+/- TRAFFIC CONTROL INSPECTION SHALL BE REQUIRED WHENEVER WORK ZONE IS SET UP ENGINEERING DIVISION APPROVED AS NOTED RECEIVED DEC 08 2023 dd/ W410,44z 12/22/2023 vv CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM WARNING SIGN SPACING • X 3 MPH 360'+l 350'+� 2&M MPH 2W+/- 2W+/ 2W+N GW1Mm ora mlIMOq (MET MPH LIPmt I Lwmw XM 30 00 MM 20 40 STOPPINGISIGHT DISTANCE RLIFFER SPACE SPEED(MPH) DISTANCE F 20 115 30 200 35 250 40 3D5 W20-1 W20-4 W20-7A LEGENDS rFLAGGER STATION TRAFFIC F DIRECTION Ca TEM .TRAFFIC DIRECTION ►►►► CHANNELIZING DEVICE N ADVANCE WARNING SIGN LOCATION ® WORK VEHICLE X ROAD ONE LANE WORK ROAD AHEAD AHEAD W20-1 W20-4 W20-7A HYDROMAX USA LEGENDS ----- LANE CLOSURE FLAGGER .... CHANNELIZING LOW SPEED STATION DEVICE WITH FLAGGERS TRAFFIC N ADVANCE WARNING DIRECTION SIGN LOCATION a TEM TRAFFIC ® WORK VEHICLE DIRECTION 100' ACTIVITY MAX. AREA a ' a a 100' MAX. 50' TO 300' W20.7A W20.4 W20 50' MIN. 100' MAX. �� w�oat 6 DEVICE MIN. ~ �X tx~ + X ► 1 a 28- TRAFFIC CONES WARNING SIGN SPACING = X 35-40 MPH 350'+/_ 350'+/_ 350'+/- 25-30 MPH 200'+/_ 200'+/_ 200'+/_ CHANNEIIZING DEVICES SPACING (FEET) TAPER TANG ENT r5 30 60 =30 20 40 HYDROMAX USA LANE CLOSURE ON RESIDENTIAL ROAD WITH FLAGGERS W20-7A W204 50' MIN. ACTIVITY 100' MAX. ONE AREA 6 DEVICE MIN. FtokD AHEAD I+ I X� �X� s X 1 28" TRAFFIC CONES TRAFFIC CONTROL INSPECTION SHALL BE REQUIRED WHENEVER WORK ZONE IS SET UP ENGINEERING DIVISION APPROVED AS NOTED jell iVLj,, 44z 12/22/2023 vv I RECEIVED DEC 08 2023 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM LEGENDS .... CHANNELIZING DEVICE ADVANCE WARNING N SIGN LOCATION En WORK VEHICLE W20-1 ROAo wows AHEAD MINIMUM TAPER LENGTH = L LANE WIOTH (FEET) POSTED SPEED (MPH) 25 30 35 40 45 50 55 60 65 70 10 11 105 270 450 500 550 115 t5O2 295 295 550 605 6W12 125 320 540 600 660 720 760 840 CNA11BIDq DEVIINIIII CN0 (IQT MPH LIPEI7 171110ENT &M 40 00 96115 30 90 20/90 20 40 RpAp CB11EA fP11ER W20-1 AIIFAD uu- X 9- W20-1 W9-3 W9-3 LEGENDS CHANNELIZING DEVICE N ADVANCE WARNING SIGN LOCATION ® WORK VEHICLE W20-1 *>x, W14 W114R I R3-2 LEFT I X L 1/2 ROAD WORK AHEAD W20-1 A )V SHALL OBTAIN TRAFFIC R3-2 ENGINEERS LEFT PERMISSION rs-1 HYDROMAX USA CENTER LANE CLOSURE NEAR INTERSECTION W9-3 W9-3 W20-1 QNf� ROAD ACTIVITY 1/2 Awe L AREA L X X X .... M X X 28• TRAFFIC X- DISTANCE BETWEEN SIGNS CONES 4&M MPH 5W4-500'41• GOO'µ 5W-hL 9640 MPH 3W-tP aBD'µ lIEO'µ a0D'µ 2S-X MPH 2O7µ 200'µ 200µ =10 MINIMUM TAPER LENGTH = L LANE WIDTH (FEET) 25 30 POSTED SPEED (MPH) 35 40 45 50 55 60 65 70 10 205 270 450 500 550 11 EO5150 165 225 295 295 550 605 660 12 125 180 245 320 540 1 600 1 660 720 780 840 R3-2 IN LEFT W20-1 ROAD WORK L 1/2 AHEAD 1/2 L I X N. R3-2 LEFT L 1/2 W1-4R I X ROAD WORK W20-1 AHEAD 28" TRAFFIC CONES TRAFFIC CONTROL INSPECTION SHALL BE REQUIRED WHENEVER WORK ZONE IS SET UP W1-4R HYDROMAX USA WORK IN CENTER OF INTERSECTION RECEIVED DEC 08 2023 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT CHANNELUM DEVICES SPACING ( FEET ) MPH TAPER TANGENT 50l10 40 80 35145 30 60 20/30 20 40 X= DISTANCE BETWEEN SIGNS 4&W MPH III500+/-I 500'+/ 500'+/- I 5w: - 3640 MPH 3W+I- 350'+f 360'+J 350'+/- 2530 MPH 2W+1- 200'+1 200'+1- 200'+/- ENGINEERING DIVISION APPROVED AS NOTED J�tV,(,gj,,f�z12/22/2023 SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM MINIMUM TAPER LENGTH = L LANE WIDTH (FEET) POSTED SPEED (MPH) 25 30 35 40 45 50 55 60 65 70 10 105 150 1 205 1 270 450 1 500 1 550 11 12 115 165 225 1 295 295 1 550 1 605 1 NO 125 180 1 245 1 320 540 1 600 1 660 1 720 780 840 OR DOWNSTREAM TAPER TO SHOW END OF WORK AREA G20-2A 00 xaornu WA4MW W SIQNVACW (FEIT) FREE WAYS & EXPRESSWAYS 55/70 MPH 1500'+/-OR PER MUTCD RURAL HIGHWAYS 60/65 MPH 800'+/- RURAL ROADS 45/55 MPH 500' +/- RURAL ROADS & URBAN ARTERIAL 35/40 MPH 350' +/- RURAL RD, URBAN ARTERIAL, RESIDENTIAL, BUSINESS DISTRICTS 25/30 MPH 200'+/- URBAN ST 1 25 MPH I 100'+/- W4-21- W20-5R W20-1 ACTIVITY SEE I AREA NOTE B L� X X X w 2'MIN. ----------------------j .-mat --l' a ---_ 1 -- ------ -- ---- V e 28'TRAFFIC * i CONES NOTE A PROTECTIVE VEHICLE IS RECOMMENDED REGARDLESS IF ATMA IS AVAILABLE. IF NO TMA IS USED, THE PROTECTIVE VEHICLE SHALL BE STRATEGICALLY LOCATED IN THE FIELD TO SHIELD WORKERS AND NO ROLLAHEAD DISTANCE IS SPECIFIED. MINIMUM TAPER LENGTH = L LANE WIDTH (FEET) POSTED SPEED (MPH) 25 30 35 40 45 50 55 60 65 70 10 105 150 205 270 450 500 550 11 115 165 225 295 295 550 605 660 12 125 180 245 1 20 1 540 1 600 660 720 780 840 OR DOWNSTREAM TAPER TO SHOW END OF WORKAREA G20-2A ao xolowau ACTIVITYSEE AR II NOTE Aoi AMWJW08IGN WACM (FEET) FREE WAYS & EXPRESSWAYS 55/70 MPH 1500' +/- OR PER MUTCD RURAL HIGHWAYS 60/65 MPH 800' +/- RURAL ROADS 45/55 MPH 500' +/- RURAL ROADS & URBAN ARTERIAL 35140 MPH 350' +/- RURAL RD, URBAN ARTERIAL, RESIDENTIAL, BUSINESS DISTRICTS 25/30 MPH 200' +/- URBAN ST1 25 MPH 1 1W +/- T MIN. ------------`— ---o- o-��--•---as--------- ® { o— Y e 28' TRAFFIC * i CONES NOTE A PROTECTIVE VEHICLE IS RECOMMENDED REGARDLESS IF A TMA IS AVAILABLE. IF NO TMA IS USED, THE PROTECTIVE VEHICLE SHALL BE STRATEGICALLY LOCATED IN THE FIELD TO SHIELD WORKERS AND NO ROLL AHEAD DISTANCE IS SPECIFIED. HYDROMAX USA LANE CLOSURE STOPPINGISIGHT DISTANCE RI IFFFR CPArF SPEED (MPH) DISTANCE (FT) 20 115 25 150 30 200 40 305 50 425 495 570 65 75 820 LEGENDS TEM TRAFFIC a DIRECTION .... CHANNELIZING DEVICE M ADVANCE WARNING SIGN LOCATION ® WORK VEHICLE SEQUENTIAL ® ARROW BOARD HYDROMAX USA LEFT LANE CLOSURE ON ATWO LANE ROAD STOPPING/SIGHT DISTANCE RIIFFFR RPACF SPEED (MPH) DISTANCE (FT) 20 115 1. 155 30 200 45 360 50 425 495 570 75 820 IFrFNnc TEM .TRAFFIC DIRECTION .... CHANNELIZING DEVICE N ADVANCE WARNING SIGN LOCATION ® WORK VEHICLE SEQUENTIAL ® ARROW BOARD TRAFFIC CONTROL INSPECTION SHALL BE ENGINEERING DIVISION REQUIRED WHENEVER WORK ZONE IS SET UP APPROVED AS NOTED ,ldl W41$,.,, 4z 12/22/2023 vv RECEIVED DEC 08 2023 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT LEGENDS rFLAGGER STATION F TRAFFIC DIRECTION a TEM .TRAFFIC DIRECTION „. CHANNELIZING DEVICE N ADVANCE WARNING SIGN LOCATION ® WORK VEHICLE MAINTAIN 11' MIN. LANE WIDTH 28- TRAFFIC CONES �c 4AH-. X X ROAD AHERADD <Wi W20-1 W204 W20-7A CHANNELONG DEVICES SPACING ( FEET ) MPH TAPER TANGENT 35/45 30 60 20130 20 40 HYDROMAX USA LANE CLOSURE MH NEAR STOP SIGN ON RESIDENTIAL STREET X- DISTANCE BETNIEEN SKINS 36JO MPH 3W+1 3W+/- 350'+/- 360'+/- 2530 MPH 2pp+1 2W+1- 200'+1- 200'+/- W20-7A W20-4 W20-1 SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM TRAFFIC CONTROL INSPECTION SHALL BE REQUIRED WHENEVER WORK ZONE IS SET UP RECEIVED DEC 08 2023 ENGINEERING DIVISION AAAP,PI'ROVED AS NOTED j Qll W,(./xai..44z 12/22/2023 CITY OF EDMONDS 1 DEVELOPMENT vv SERVICES DEPARTMENT SIGN SEQUENCE A W20.4 W20-7A __ W20-1 POND �� naw� X X X LEGENDS rFLAGGER STATION TRAFFIC DIRECTION a TEM .TRAFFIC DIRECTION .... CHANNELIZING DEVICE M ADVANCE WARNING SIGN LOCATION ® WORK VEHICLE ATTACH SIGN SEQUENCE (A) 50' MIN. f 100' MAX. 6 DEVICE MIN. 1 X X -50' MIN. 100' MAX. 6 DEVICE MIN. W20.1 W20.7B W20-7A NOTES: 1. FLAGGER STATION SHALL BE IN LINE OF SIGHT OF APPROACHING VEHICLES. 2. FLAGGER SHALL MAINTAIN RADIO COMMUNICATION. 3. FLAGGERS TO ASSISTS PEDESTRIANS ACROSSIAROUND WORK ZONE. HYDROMAX USA 28'TRAFFIC ROUNDABOUT a CONES ATTACH SIGN 50' MIN. SEQUENCE (A) 100' MAX. 6 DEVICE MIN. q . 1 50' MIN. 100' MAX. 6 DEVICE MIN. X W20.7A X °fsT°o ED W20.7B X n SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM TRAFFIC CONTROL INSPECTION SHALL BE REQUIRED WHENEVER WORK ZONE IS SET UP RECEIVED DEC 08 2023 ENGINEERING DIVISION APPROVED AS NOTED '' IIII CITY OF EDMONDS jX WQ✓..il a$,442 12/22/2023 DEVELOPMENT vv SERVICES DEPARTMENT Site plan SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM TRAFFIC CONTROL INSPECTION SHALL BE REQUIRED WHENEVER WORK ZONE IS SET UP RECEIVED DEC 08 2023 ENGINEERING DIVISION APPROVED AS NOTED '' II,, CITY OF EDMONDS fill Q✓1re,44,g 12/22/2023 DEVELOPMENT W SERVICES DEPARTMENT Addresses 9703 241ST PL SW 6909 16OTH ST SW 336 SUNSET AVE 540 #101 MAPLE ST 7615 2O6TH ST SW 755 DALEY ST 19510 88TH AVE W 10615 226TH ST SW RECEIVED DEC 08 2023 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT RECEIVED DEC 08 2023 CITY OF EDMONDS M BuildingPermit.com CITY OF EDMONDS Right -of -Way Application #1413883 - CCTV Sewer inspections for PSEERVICESLOPMENT D PARTMEM Applicant First Name Last Name Company Name Jaimee Forman Hydromax USA, LLC Number Street Apartment or Suite Number E-mail Address 6500 Ursula PI S Seattle, WA 98108 jaimee.forman@hydromaxusa.com City State Zip Phone Number Extension Seattle WA 98108 (206) 702-8382 Contractor Company Name Hydromax USA LLC Number Street Apartment or Suite Number 6500 Ursula PI S City State Zip Phone Number Extension Seattle WA 98108 (206) 702-8382 State License Number License Expiration Date UBI # E-mail Address HYDROUL870JS 4/22/2025 FD.'19r;nng7 jaimee.forman@hydromaxusa.com Project Location Number Street Floor Number Suite or Room Number 9703 241 ST PL SW City Zip Code County Parcel Number EDMONDS 98020 00450200000200 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 Ronald L & Alice M Terrel Number Street Apartment or Suite Number 9703 241 ST 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: 12/7/2023 Submitted By: Jaimee Forman Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Right -of -Way Application #1413883 - CCTV Sewer inspections for PSE Project Contact Company Name: Hydromax USA, LLC Name: Jaimee Forman Email: jaimee.forman@hydromaxusa.com Address: 6500 Ursula PI S Seattle, Phone #: (206) 702-8382 WA 98108 Seattle WA 98108 Project Type Activity Type Scope of Work Utility Purveyor Utility Work No Disturbance of Surface Project Name: CCTV Sewer inspections for PSE Description of Work: CCTV Sewer inspections for PSE's Cross Bore Safety Program. Non-invasive routine maintenance. 30-90 minutes per location. Project Details Project Information Job Number 1499 Page 2 of 2