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ENG2024-0029 ROW PERMITRIGHT OF WAY EUC PERMIT PERMIT NUMBER City of Edmonds 98020 www.edmondswa.gov i Description: PSE-INSTALL TEST LEADS & ANODES ON GAS MAIN IN SOFT SURFACE ISSUED: 02/20/2024 Address: 18921 78TH AVE W EDMONDS WA 98026 EXPIRES: 08/20/2024 Permit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00418000003201 NAME TYPE NAME ADDRESS PHONE APPLICANT COURTNEY XIONG 6500 URSULA PL S, SEATTLE WA 98108 (206)348-0676 CONTACT PUGET SOUND ENERGY 6500 URSULA PL S, SEATTLE WA 98108 (206)348-0676 CONTRACTOR PSE/INFRASOURCE 1660 PARK LANE, BURLINGTON WA 98233 (425)466-4771 OWNER RICHIKO BUSLACH 8821 188TH ST SW, EDMONDS WA 98026-5922 FEE INFORMATION DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE - PER PERMIT $45.00 $45.00 ENG - INSPECTIONS $126.00 $126.00 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: 02/20/2024 Printed: Tuesday, February 20, 2024 12:30:21 PM 1 of 2 RIGHT OF WAY EUC PERMIT PERMIT NUMBE3 City of Edmonds ,...Ave N, Edmonds WA 9:01 11 • 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** Printed: Tuesday, February 20, 2024 12:30:21 PM 2 of 2 RECEIVED Lti�y of EDdf04O� ANC. 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. JAN 26 2024 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• Project Name 109152685 - 11980777 Site Address or if no site address use Property Address at NW corner of project area: Associated Permits: BLD PLN ENG X Owner and Entity Holding• .• - Name of Company Puget Sound Energy Franchise Ordinance No: Point of Contact Courtney Xion Title Program Maintenance Coordinator Address 6500 Ursula PI S City Seattle State WA Zip 98108 Phone 206-348-0676 Email courtney.xiong@pse.com Contractor and Authorized Agent of • Name of Company Puget Sound Energy • - •• •w) Contractor ContactsDuring Construction Primary Name Matt Scofield Agent Name Courtney Xiong Title Corrosion Control Technician Title Program Maintenance Coordinator Mobile 206-719-0946 Address 6500 Ursula PI S Email matt.scofield@pse.com City Seattle I State WA Zip 98108 Secondary Name Courtney Xiong Phone 206-348-0676 Title Program Maintenance Coordinator Email courtney.xiong@pse.com Mobile 206-348-0676 City of Edmonds Business License No: Email courtney.xiong@pse.com State License No: PUGETSE032A R Contractor verifies it is currently bonded Contractor verifies it currently has general liability insurance NOTE: ECDC 18.6o.02o 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? Q Other, please specify: Utility Gas Work rR 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 ❑ 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.) Expose 2" STW IP gas main and install two test lead wires and two 20# anodes in soft surface at edge of street paving. Will have one (3'x5') soft surface cut anticipated. Work Duration approximately 6-8 hours. 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 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 u gas ❑ water ❑ sewer ❑ storm 1. CompletedDetails of Work to be Does the utility owner have existin overhead infrastructure in the area of work? • X 2. Will any equipment be added underground or above ground (e.g. pedestals, vaults, etc.)? X If yes, describe: test lead wires and anodes 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 system? X 5. Does the work involve proposed additions to an aboveground utility system? If es: X 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? X 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: X How many are existing? I I How many are to be added? 1 2 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? dd 6c. Are any poles to be modified/rebuilt/replaced? If yes: X How many? I I What is the height of the poles after? aiii 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: C__&u'uM_915(_ ADATE: 01/23/2024 APPLICANT PRINTED NAME: Courtney Xiong APPLICANT TITLE: Program Maintenance Coordinator NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 Job #: 109152685 Date: 1/8/24 Jurisdiction: Edmonds Right of Way Permit? ❑✓ YES ❑ NO Est. Start Date: 02/08/24 Est. Duration: 1 Day PRE -INSPECTION REPORT Address: 18921 78th Ave W RECEIVED JAN 26 2024 QPOGET SOUND ENERG r City / Zip: Edmonds, 98026 DEVELOPMENT NT Customer: PM / Insp: Matt Scofield 206-719 0946 PHONE NUMBER WORK DESCRIPTION: Construction Method Trenchless ❑ Install two 20# anodes and T/L wires on 2" STW IP Main. Bring wires up in new wirebox. Open Trench ❑ New Construct ❑ Existing N SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM ' I 8903 I Q I — Location: 103' N c/I Dellwood Dr & r 18' E c/I 78 Ave W 7so w Dig/Cut TxT 40" SHLDR Applicant shall repair/replace all damage to utilities or frontage _ Z f' improvements in City right-of-way 1900L1 per city standards that is caused or = ork Area: occurs during the permitted project. SQFT ENGINEERING DIVISION APPROVED AS NOTED _ ,IQ�/ (AlQ✓.,irH.,,np 02/15/2024 Work Location Size of Cut Surface Type �Q 'N of CL Dellwood Dr &_Jf— 'E of CL 78th Ave W 3x5 Grass 'N of CL & 'E W of CL 'N S of CL & 'E W of CL 0 FLAGGERS # 2 25 MPH ❑ TROLLY LINES ❑ BUS STOP # ❑ METER HOODS # ❑ OFFICERS # SPEED LIMIT ❑ TRAFFIC SIGNAL ❑ ARTERIAL ❑ NO PARKS # ❑ Commercial ❑ Altered Commercial ❑ Leak Repair Service Information ❑ Template Bar ❑ Residential ❑ Altered Residential ❑ CP Work Diameter Meter EFV Pressure ❑ Bollards 2.5" # ❑ Multi -Family ❑ Replacement Service ❑ Pothole ❑ 5/8" ❑ 250 ❑ 1800 ❑ 6" WC El Bollards 4" # ❑ New Constr. ❑ Main Maintenance ❑ Extension ❑ 11/8" ❑ 425 ❑ 2600 ❑ 2# ❑ Stub ❑ Service Maintenance ❑ 11/4" ❑ 630 ❑ 10,000 ❑ > 5## ❑ FUEL LINE PERMIT NEEDED ❑ Extension ❑ Valve Maintenance ❑ 2" ❑ 1000 Fuel Line Length: ❑ Compete Sery ❑ Cut & Cap Mtr Loc: Fuel Line Diameter: OWNER/CONTRACTOR IS RESPONSIBLE FOR OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING EROSION CONTROL AND DRAINAGE ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY UTILITIES MAY REQUIRE A SEPERATE PERMIT. TEMPORARY TRAFFIC CONTROL PLAN USE MAXIMUM AVAILABLE SPACE FOR SIGNS o C1V3Hb cv NKM aV02i GV3HV GV08 0 3NV13NO 011 o � fV • / RESIDENT(S) WILL BE INFORMED OF POSSIBLE TEMPORARY DRIVEWAY CLOSURE USE MAXIMUM AVAILABLE SPACE FOR SIGNS RECEIVED JAN 26 2024 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT 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 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 as per jurisdictional requirements. (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. All Flagger and Downstream tapers shall be 50'-100'. 9. Work area will be 103' North of centerline of DELLWOOD DR, and 18' East of centerline of 78TH AVE W. DEAD END �NE x< I I tl3btl Atl:V MOl SNIN Vd • F1 \,- 0I 00 ENGINEERING DIVISION /Q APPROVED AS NOTED ,%]] (, 4,.J,µ.44z 02/15/2024 VV SIGN SPACING MPH "X" 60/65 1000, 45/55 500' 35/40 350' 30 200' 25 100' CHANNELIZATION DEVICE SPACING MPH TAPER TANGENT 55/70 40 80 35/45 30 60 25/30 20 40 LL z O Q W U) p Q LU U � ry Q O r m PARKING TOW AWAY AREA 18921 78th Ave W Edmonds WA 98026 USA USE MAXIMUM AVAILABLE 7A SPACE FOR SIGNS 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 PUGET Designer: SOUND Matlock Highbarger ENERGY (808) 375-4152 Project Address: Matlock.Highbarger@PSE.com 18921 78th Ave W, Edmonds, WA LEGEND WORK PIT ® 28" TRAFFIC CONE =i TRAFFIC FLOW WORK VEHICLE/ FLASHING LIGHTS SIGN LOCATION RIGHT OF WAY ROW — - WORK AREA OCHEVRON ARROW BOARD UNIFORMED POLICE OFFICER FLAGGER Puget Sauna Energy Traffic Control Supervisor: Gregory"an"00 Card No. ES2 000299 Card Exp. 09/30/2027 9regory.hawocd@pse.com 01/11/2024 REV 0 Job # (425924-6425 11980777 Page 1 OF 1 RECEIVED JAN 26 2024 CITY OF EDMONDS M BuildingPermit.com CITY OF EDMONDS DEVELOPMENTRight-of-Way Application #1432345 - PSE - 18921 78 Ave W SERVICES DEPARTMENT Applicant First Name Last Name Company Name Courtney Xiong Puget Sound Energy Number Street Apartment or Suite Number E-mail Address 6500 Ursula PI S courtney.xiong@pse.com City State Zip Phone Number Extension Seattle WA 98108 (206) 348-0676 Contractor Company Name PUGET SOUND ENERGY INC Number Street Apartment or Suite Number 6500 Ursula PL S City State Zip Phone Number Extension Seattle WA 98108 (206) 716-2641 State License Number License Expiration Date UBI # E-mail Address PUGETSE032J 1 3/20/2024 179n 1 M55 courtney.xiong@pse.com Project Location Number Street Floor Number Suite or Room Number 18921 78TH AVE W City Zip Code County Parcel Number EDMONDS 98026 00418000003201 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 Richiko Buslach Number Street Apartment or Suite Number 8821 188TH ST SW City State Zip EDMONDS WA 98026-5922 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: 1/23/2024 Submitted By: Courtney Xiong Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Right -of -Way Application #1432345 - PSE - 18921 78 Ave W Project Contact Company Name: Puget Sound Energy Name: Courtney Xiong Email: courtney.xiong@pse.com Address: 6500 Ursula PI S Phone M (206) 348-0676 Seattle WA 98108 Project Type Activity Type Scope of Work Utility Purveyor Utility Work Disturbance of Surface Project Name: PSE - 18921 78 Ave W Description of Job# 109152685 - 11980777 Expose 2" STW IP gas main and install two test lead wires Work: and two 201b anodes in soft surface at edge of street paving. One (3'x5') soft surface cut anticipated. Work duration approximately 6-8 hours. Project Details Project Information Job Number 109152685 Page 2 of 2