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�
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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
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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
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3 MPH 360'+l 350'+�
2&M MPH 2W+/- 2W+/ 2W+N
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20
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STOPPINGISIGHT DISTANCE
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35
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ENGINEERING DIVISION
APPROVED AS NOTED
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RECEIVED
DEC 08 2023
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM
LEGENDS
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DEVICE
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N SIGN LOCATION
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POSTED SPEED (MPH)
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10
11
105
270
450
500
550
115
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295
295
550
605
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125
320
540
600
660
720
760
840
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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
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WORK
L 1/2 AHEAD
1/2 L I X
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R3-2
LEFT
L
1/2
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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
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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
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FREE WAYS &
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55/70 MPH
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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'+/-
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AREA NOTE
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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
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60/65 MPH
800' +/-
RURAL ROADS
45/55 MPH
500' +/-
RURAL ROADS & URBAN
ARTERIAL
35140 MPH
350' +/-
RURAL RD, URBAN
ARTERIAL, RESIDENTIAL,
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25/30 MPH
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NOTE
A PROTECTIVE VEHICLE IS RECOMMENDED REGARDLESS IF
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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
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LEFT LANE CLOSURE
ON ATWO LANE ROAD
STOPPING/SIGHT DISTANCE
RIIFFFR RPACF
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DISTANCE (FT)
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30
200
45
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REQUIRED WHENEVER WORK ZONE IS SET UP APPROVED AS NOTED
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RECEIVED
DEC 08 2023
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
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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
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50' MIN. f
100' MAX.
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X X
-50' MIN.
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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
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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
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