ENG2023-0005_City_Application_9.17.2023_8.34.03_AM_3787521ENG2023-0005 RECEIVED
{tj Qf �M�4. Sep 18 2023
RIGHT OF WAY CONSTRUCTION
CITY OF EDMONDS
DEVELOPMENT SERVICES
PERMIT APPLICATION DEPARTMENT
Complete and submit this Application in accordance with the Submittal
1391 Requirements outlined in R.ieht-cif-Way permit Handout E&j.
If any field is not applicable to your project, write "N/A" instead of leaving blank.
All Selth; required. Incomplete Applications will be denied.
SECTION A
Project Name
S tt Addmu or 1 no ' uw Prolmly .Wdmuc at `'W cnrrxr of pmjcnt area-
r>ssacielyd Pcrmitc IiLU cs — t Z�� rt w o — d o-) 3 t u2o .�, —,p 0 gbS—
•DuringConstrudion
Same of comp:m}
Mint lame T
Title �
Title Pr
Mullite .
?mil169.Tt„i
.Name
Title
uwrv� Vt; 1
City � �
Ste_ WIC 7rp �
Plume .a 7.
FMW Y A r. "AA 0-. I r. I .
A "n '
(3ty ofFdn on& Ma*u" LiAxnac tio:
Enud)
Statr t.tcemac w►: VgI.A
x Cruttradormi ies it is currently tot
Conttne2or+tribes it uuretttly 6ax k liabitil> ltmurwxr
,vQTE: Ems 18.60.00 mvuim that tM.ippi4nt6rn Ire Payne! Iry o lioertsotl and bortdad contractor unless uthe raise amnimi Ay tAr �
eminerr.
o :4InftifBmilvresiclrntial Commercial r-City project
A Single family msidential mihdivittion (Single family -either r- hulttutrial
-vt Demn and rebuild or from vacant land?
mOther, plmw specify:
Utft Franchise Work associated with ck velopment (check one of thr above bates as tucll )
a. Traffic Control Onla (no associated development)
City of Edmonds ROW construction perntit Application —Prise t of 3 Updated 3/^5/2021
Z
2
a Utility Franchise Work (no asimiated development)
RECEIVED
Sep 18 2023
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
Include an overall narrative: description of the propru;ed work. Be specific and detailed:
Describe infrastructure to be impacted, -such as. poles, wines, conduit, utility mains. etc.
Include whether this is.consUuction, maintennnee, or repair.
Include description of proposed methods, (e.g., bares. trenehm overhead wires prolx)*;ed, depth for
underground utilities, etc.)
RIGHT -OF WAY
CLOSURE
AREA
TOT.U.
DURATION
(Number of Mcmths)
Sidewalk 72 hours +
LF
I x
T.F
SF
A -
Alley 72 hours +
I LF
x
LF
SF
-sr-
r
Parking hours
I jqld LF
x
LF
1
SECTION B - you are not a utility company performing umrkin the Gyty ROW.skip to SRCI IUN G.
1. The work in the right osf way is on or for the following type of facilities:
telecummunkafionx cable =. pQ«er -'gas
water a sewer storm '
L. I Does the utility• wwner have existing overhead infrastructure in the area of work?
2 1 Will am, equipment be added underground or above ground ty.g. •destab- vaults etc.)?
If yes. describe:
3.
Does the proposed work rt nncet a lot or codevelopment with utilities that I%e ve mare
than one lot or commercial development?
4.
Does the wnrk involve rebuilding or relocating an existing Axwegrriund utility mtem which
connects a lot or commercial development to an existing undgWound common utility system?
Does the %%vrk involve proposed additians to anabcneffound udhty ovstem? If yes:
Are the additions for the purpose ofjg►tg new commercial development?
Are the additions for the porpose of serving a sin v residential subdivision?
6. 1 Dcx,--, your prop-vi involve rebuilding or replacing; utility equipment which currently servim mom
l than one lot car commercial development?
Litt• of Kdmonds KoW constnicuon permit Application —Page 2 0(3 tlpdatc-J;t/ ,y/2o:u
Qt=rt=tvt=n
t(ye s. answer the following questions related to project area, i.e. the actual area in which the Sep 1 2023 i
project t.4 ro ged: CITY OFE MONDS
rr��
6a.
Does your pmjee.•t involve Wires/cablesjlincs? If yeas: DEPAR MENT
How many arc eaistin ? I I How many are to be added?
6b. Does your project involve poles? if yes:
Hens many poles are. existing in the project area?
Whet is the height of the exibtinpoles?
How man • poles are to be removed?
Are additional x)leye to be laced?
How many? I I What is the height of the additionalpoles?
6c. Are any poles to be modified/rebuilt/replaced? If yea:
How many? I I What is the height of the poles after?
i escribe the modification/rebuild.-
SECTION C
Traffic Control and Public Safety. Traffic eontml and public safetyshall bo in accordante with City rv%ulations as
required by they City Engineer. Evezy ftagger must be b-ained as requited by WAC 296-1Sg-3o5 and must have
certification verifying completion of the required training in their possession.
Restoration. Restoration shall be in accordance with City "ex ;end StandAds. All street cut trench work shall be
patched with asphalt or City ;approved material prier to the end of the workday -AO F>CE:P'i'lONS.
Insurance. The City may rt-quire the owner or contractor to provide proof of insurance acceptable to the City prior in
any permit approval.
indemnifeattion. The Applicant agrees to de'fend, indemnify-. and hold harmless the City of F,dmonds, its officials,
offices+, rmployees, and agents against aay injuries, damages. or claims of any kind or description whatsoever.
foreseen or unforeseen, including defense costs and attar ucy frees, resulting direcdy or indirectly from any act or
emission of tbe.Applicant, its sukontrnetots, anyone directly or indirectly employed d by them, and anyone for whose
acts or omissions ey may be liable, wising out of, related to, or by reason of the granting of this permit; and
specif:calh• including but not limited to all loan by the failure of the Applicant to fully or adequately perform. in any
respect, all authorizations or obligations under the permit. These indemnification requIm mejntx shall survive the
expiration, rcn•exation, or termination of any resulting permit approval.
Acceptance of terms, conditions, and requirements. Applicant accepts the terms, conditions, and
requirements set fortis in thisApplication and agrees they apply to any resulting permit and shall comply with therm 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 •litlr tfl; 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 itx behalf and have : udwrity to ' d the owner to this application.
Feee_y. The Applicant is reslxmssibl it f
APPLICANT SIONATURF- EZATE: C' /C/23
APPLICANT PRINTED.NAM1s IZPALAt-
Y 'Qn g e
r
NO WORK SHALT. BEGIN PRIOR TO PERMIT ISSUANCE
Cih• of Edmonds ROW construction 1wrmit Application—Pagr 3 of 3 Updated 3/25/2021