ROW PERMIT APPLICATIONof EVA-10
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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 887033545
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASI-871 C2
City Business License #: NR-019840
CONTACT:
Susan Sidick
Phone #: 425-457-6353
Fax #:
Email #: susan.sidick@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 416 Dayton Ave
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑ Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes ❑* No
l ANY ASSOCIATED PERMITS? I L
BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) :
Break out new concrete sidewalk panel and expose new water service crossing at above x/y
location. verity it shorted and it possible try to wrap and sip new insulating muc e e een e
Ras and water. Under .iob # 887033545
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES ❑ NO ❑ Year:
PAVEMENT CUT: ❑ Yes ❑ No If yes, indicate size of cut: x_
CONCRETE CUT: [X Yes ❑ No If yes, indicate size of cut: x
RIGHT-OF-WAY
AREA
CLOSURE
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF
X
LF
SF
Alley 72 Hrs + LF
X
LF
SF
Parking 72 Hrs + LF
X
LF
SF
APPLICANT TO READ AND SIGN
*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 is to 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.
Indemnity: The Applicant has signed an application which states he/she hold 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 defense -costs and attorney fees by reason
of granting this permit.
I have read the above statements and understand the permit requirements and acknowledge that I must
follow all requirements in order for the permit to be valid.
SIGNATURE
6XVDQ6LGLFN
Contractor or Agent
DATE
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Job #: PRE -INSPECTION REPORT 001'UGETSOUND ENRGY
Date: Z // 3. /2o zo
Jurisdiction: �'� * o f?n�yk,
Right of Way Permit. R]YES ❑ NO
Est. Start Date:
Est. Duration:
Address:
City / Zip: �drxe.rolr
Customer: &�� ,fog E �+=.
— 11 - iP B
PM / Insp: %Nff-ryo' fovoe— 20G. 937. 9 /76
PHONE NUMBER
WORK DESCRIPTION: zn S� �� w ,
Construction Method
❑
ose, n�J Wat�Gr 5--et-vice anc✓ ex�s�,., cis rH��t crorf�:z
P .9 9 .9•
Open Trench
Open Ten
❑
.S-Pe -ICA bz%eeh d,�/ �r`GS'.
New Construct
❑
Existing
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Work Location
Size of Cut
Surface Type
a of CL D f»,7 fT & JY 3 'IFf CL 5 4-* 5 .
3' x 3 '
nc� r, {�
'N S of CL & 'E W of CL
'NSofCIL & 'EWofCL
FLAGGERS # 2 ?irJ MPH ❑ TROLLY LINES BUS STOP # aZ,�7'V-f- ETER HOODS #
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❑ OFFICERS # SPEED LIMIT ❑TRAFFIC SIGNAL ❑ARTERIAL v G rt.4- 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 ❑ "cement 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:
Puget Sound Energy
Traffic Control Supervisor:
Gregory Harwood
Card No. 012238
Card Exp. 09/30/2023
gregory.harwood@pse.com
(425)424-6425 p
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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 11' for
traveling lane width.
6. Alert affected residents and businesses.
7. Work to take place between 9 a.m. and 4 p.m
unless otherwise specified. All work for arterials
and major roadways will be from 9 a.m. to 3 p.m
8. Work area will be Work area will be 19' NCL of Dayton
St & 143' WCL of 5th Ave S.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
0
W20-1
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TEMPORARY TRAFFIC CONTROL PLAN
MOVE BUS STOP 400' WEST.
COMMUNITY TRANSIT WILL BE
CONTACTED AT 425-353-7433
FIVE DAYS IN ADVANCE OF
SCHEDULED DATE.
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12112 maintain (2) 11' lanes min.
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PUGET
SOUND
ENERGY
JOB# 887033545
416 DAYTON ST, EDMONDS, WA 98020
2/19/2020
jason.bisenius@pse.com
1 12112 1
12i12
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
25/30
20
40
425-424-7316
SHEET 1 of 1
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100100' 1
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DAYTON ST
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ROAD
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WORK o
N
AHEAD
LEGEND
SIGN SPACING
MPH
"X"
60/65
1000,
45/55
500,
35/40
350'
0
125
200'
100,
®
28" TRAFFIC CONE
®
WORK PIT
=>
TRAFFIC FLOW
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
— Row
PERMIT REQUEST FORM
Date of Request: 02/18/20
Job number:
Job address
Project mgr:
PM email:
887033545
416 Dayton Ave
Betty Frank
betty.frank@pse.com
Estimated job start date:
03/30/20
Estimated job completion date: 03/30/20
City: Edmonds Zip.
PM contact #. (206) 716-2641
Description of work to be performed:
Break out new concrete sidewalk panel and expose new water service crossing at above
x/y location. verify if shorted and if possible try to wrap and slip new insulating mucket
between the gas and water.
Pavement cut? ❑✓ Yes ❑No
If yes, Dimensions of Cut: Length 3'
How many cuts? 1
Surface Type hard asphalt
Require trenching? Eyes ❑No
If yes, Dimensions of trench: Length_
Method of installation:
Traffic impact:
Road closed ❑Yes
❑ No
Lane closed [?]Yes
❑
No
Shoulder closed Eyes
❑ No
Sidewalk closed
❑Yes
❑
No
Width 5'
N/A
Width N/A Depth N/A
How Many? Direction? west
Emergency Contact: thane sonde Print Send
Cell Number: (206) 437-9170
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