ENG2022-0584+City_Application+12.5.2022_2.56.30_PM+3252753u
t= L L) 1k l C) A
SECTION A
RIGHT OF WAY CONSTRUCTIOmw�
N
PERMIT APPLICATION
Complete and submit this Application i
Requirements outlined in Right�of�Wal
I
f any field is not applicable t
111 fields required
n accordance with the Submittal
� permit Handout E e
o your project, write "NA" instead of leaving blank.
. Incomplete Applications will be denied.
NOTE: ECDC 18.60.020 requires that the Application be signed by
oigineer.
❑ Multifamily residential
❑ Single family residential subdivision
❑ Demo and rebuild or from vacant land.?
❑ Other, please specify:
❑ Utility Franchise Work associated with development (check oneorthe above boxes as well)
❑ Traffic Control Only (no associated development)
a licensed and bonded contractors unless otherwise approved by the city
❑ Commercial
4ingle family-other
[:i
❑ City project
Industrial
CAY of Edmonds ROW construction permit Application --Page 1 of 3
Updated 3/25/2021
A 'Y
❑ 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.)
RIGHT-OF-WAY
AREA
'TOTAL
DURATION
CLOSURE
(Number of Months)
Sidewalk 72 hours +
.- LF
x
LF
SF
04
Alley 72 hours +
LF
x
LP'
; SF
Parking 72 hours +
LF
Y
- LF
SF
SECTION B - If you are not a utility com�a�iy performing work in the City ROW, ski
1. The work in the right of
i:i telecommunications
Ei water
way is on or for the following type of facilities:0
o cable ❑ power
❑ sewer
1:1 storm
i:i gas
to SECTION C.
L Does the utility owner have existing 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 undergrou nd 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 con-imercial 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 COI1StI'UCt10I1 pCI'rillt Application— Page 2 Of 3 Updated 3/2,,9/2021
If yes, answer the following questions related to project area, i.e. the actual area in which the
prqject is proposed:
6a.
Does your project involve wires /cables/l ines .9 If yes:
How many are existing?
How man are to be added?
6b.
Does your project involve poles? If yes:
How many poles are existing iii the L)rqject area?
What is the height of the existing p
How many pare to be removed?
Are additional poles to be placed?
How many?
What is the height of the additional poles.?
6c.
Are any poles to be modified/rebuilt/replaced? If yes;
How many?
I
I 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,
1P
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 o r 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 granti
specifically including but not limited to all loss by the failure of the Applicant to fully or
9 0 0 a
ng of this permit; and
adequately perform, in any
respect, all authorizations or obligations uncter the permit. i nese inaemnincanon requiremen
expiration, revocation, or termination of any resulting permit approval.
ts shall survive the
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 peKjui7y 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 ani authorized b
y
owner to act on its behalf and have authority to bind the owner to this application.
Fees. The Applicant is responsible for all permit � s.
ArPLICANT SIGNATURE: � 'L.--'� DATE:
APPLICANT PRINTED NAME: ---
APPLICANT TITLE:
A4
, r
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
T
City Of Edmonds ROW C011StI t1Ct10I1 hermit Application--P��e 3 of 3 Updated 3/25/2021