ENG2023-0568+City_Application+11.3.2023_4.23.33_PM+3881231Of EDtitO�
os RIGHT OF WAY CONSTRUCTION
PERMIT APPLICATION
Complete and submit this Application in accordance with the Submittal
ANC. 1590 Requirements outlined in Right -of -Way permit Handout E6.,i.
If any field is not applicable to your project, write "N/A" instead of leaving blank.
All fields required. Incomplete Applications will be denied.
SECTION A
General•
Project Name Sound View Plaza Repairs
Site Address or if no site address use Property Address at NW corner of project area: 130 end Avenue South, Edmonds, WA 98020
Associated Permits: IBLD 2023-0992 PLN N/A ENG N/A
Owner and Entity Holding
Name of Company Jim Pattison Developments (U.S.) Inc. Franchise Ordinance No: N/A
Point of Contact Tom Locke
Title Senior Manager, Projects and Facilities
Address 205 - 15691 104th Avenue
City Surrey, BC V4N 2H4 State N/A Zip N/A
Phone (604)488-5252
Email Locke@jp-developments.com
Contractor and Authorized Agent of Owner
Name of Company Pacific Building Envelope, Inc.
(see note below)
Contractor Contacts During Construction
Primary Name Sean Cardinal
Agent Name Jon Walkley
Title Superintendent
Title President
Mobile (425)350-3152
Address 17120 9th Ave SE
Email Sean@pacificbuildingenvelope.com
City Mill Creek
State WA
Zip 98012
Secondary Name George Strong IV
Phone (425)512-8455
Title Project Engineer
Email Jon@pacificbuildingenvelope.com
Mobile (206)822-0013
City of Edmonds Business License No: 603099127
Email George@pacificbuildingenvelope.com
State License No: PACIFBE890J1
I1 Contractor verifies it is currently bonded
Contractor verifies it currently has general liability insurance
NOTE: ECDC 18.6o.o2o requires that the Application be signed by a licensed and bonded contractor unless otherwise approved by the city
engineer.
Type of •
❑ Multifamily residential 12(Commercial ❑ City project
❑ Single family residential subdivision ❑ Single family -other ❑ Industrial
❑ Demo and rebuild or from vacant land?
❑ 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 i of 3 Updated 3/25/2021
❑ Utility Franchise Work (no associated development)
• - - • •
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.)
Replace siding and windows on West South and East elevations In -kind decayed framing repair as discovered Insulation replacement as
discovered. Alley on West elevation will be occupied full length of building x 2ft wide for pump jack stagging and temporary fencing with
black inesi installed to isolate work hom public.
At Fast P.IpNiatinn we will occ, 1py a portion of the sidewalk 4ft wide x length of b, filding for p, imp jack stagging and temporary fencing with
black mesh installed to isolate work from public. 5ft 6" width of sidewalk will be maintained at all times to avoid disturbance.
RIGHT-OF-WAY
CLOSURE
AREA
TOTAL
DURATION
(Number of Months)
Sidewalk 72 hours +
4 LF
x
60 LF
240 SF
4
Alley 72 hours +
2 LF
x
1 oo LF
200 SF
4
Parking 72 hours +
N/A LF
x
LF
N/A SF
N/A
SECTION B - If you are not a utility company performing work in the City ROW, skip to SECTION C.
of Utility Facilities
1. The work in the right of way is on or for the following type of facilities:
❑ telecommunications
❑ water
❑ cable
❑ sewer
❑ power
❑ storm
■:.
Details of Work to be Complete& Yes
1. Does the utility owner have existing overhead infrastructure in the area of work?
No
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?
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?
What is the height of the additional oles?
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 qRnlit fees.
APPLICANT SIGNATURE:
APPLICANT PRINTED NAME: Jon Walk)
APPLICANT TITLE:
President
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
• 10/16/23
City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021