ENG2023-0005+City_Application+9.17.2023_8.34.03_AM+3787521j of te2
M0'y
MIGHT OF WAY CONSTRUCTION
PERMIT APPLICATION
0)mplele and submit this Application in accordance with the Submittal
tin Requirements outlined in Riglit-of-Wa% pti-mit Handout E63.
If any field is not applicable to your project, write "N/A" instead of leaving blank.
All Be1ds requinxl. Incomplete Applications will be denied.
SECTION A
Pro)ed Name C.Ue.
Sttr Addn%b ar it tut site use ProprnN Ad in-vi t NN rnrnrr if pmjwt are-
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Title
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Starr
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Title
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Cite of lEdaztm& Bu4nesa t.wcneie %*:
lvmtdl
Stair t.lreem w e t) R lA (, 015 7 -Jr
y Crwdrador-%=sFA% it is carmntly butuW
p. Contlacctw twifiea It earnestly has k al liaNMi uu unuxv
'WrE.:•• 11:W it AOAVO requmm that tM.4M1kotkw Ne,dynr d hP n liccrrmf and bnnded ewraraw unless tWwrwiw aE+pmLwd by the rile
c�yinerr.
commemal r City project
a Single family residential subdivittion ?<Single faintly-tither—indmtrial
-►n Demo and rebuild or from v uant land?
Other, please specify:
Utility Franchise Work associated with din-clopment (check one of the above 6.ies as turtl)
Traffic Control Or& (no associsat,-d d whipment)
Ot% of r4intonda ROW construction lu•nnit Application —Page t of ;s tipdatrd 3/^5/2021
Z
2
a Utility Franchise Work (no aaRxiated development)
Include an overall narrative description of the prupmwd work. Be specific and detailed:
Describe infrzustructtm lu be impacted, such nit, poles, wires, conduit, uttflity mains. etc -
In
clude whether this is construction, maintennnee, nr repair.
Include description of proposed conshatetion methods, (e.g., bares. trenches, overhead wires proposed, depth for
underground utilities, etc.)
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RIGHT-OF-WAY
CLOSURE
AREA
TMAL
DURATION
(Number of Months)
Sidewalk 72 hours Y
LF
x
1 440 LF
SF
Ailey 7-,, hours +
IF
x
LF
SF
Parkin 1 hours
I 4V.A LF
x
LF
SF
SECTION B - If you are not a utility company performing u urk- in the City ROK', sl�zjf try SF.['1'IUN G.
i. Tht ►v„rk ut the right 4 i%ay ix tm or far the fallowing t}W of facilities: :
- lelecummunications a cable = PCrWer =has
water C: sewer storm '
t. Dues the uttdm owner hn%,c existing overhead infrastructure in the area afwork?
2 Will unv equipment be added undrrground or above ground ,pedestab, vaults etc.)?
If , dcsrrihe:
;;.
Does the proposed work rvnnect a tot or commercial de%*l(wl)ment with utilitiex that !serve Crewe
than one lot or commercial develn ent?
.t.
Does the wmrk inv(A%,r rebuilding or relocating an existing aixivr_gmund utiiity s3Ntem which
connects a lot or comnwrcW devekt ment to an existing ound common utilitv svatem?
Dues the w-nrk invoh$ proposed additions to anabcn-effound utibty syswm? tf vim:
Are the additionx for the purpose of §gnIM new commercial develo men!?
Are the additions fnr the purpose of serviny, a v residential subdivision?
Oty of Edmonds ROW consummon permit Application —Page 2 of 3 Updated 3!2.51mai
If yes. answer the fallowing questions related to project area, i.e. the actual area in which the
project is ro o::ed•
i
6a.
Does your project involve wires/cablesAnes? ifyvs;
How many arc existin ? I I How man• are to be added? I-
6b.
Does your project involve poles? if yes:
Howmam• Pairs am exisfm in the project area?
What is the height of the taxis 'poles?
How than • poles are to be removed?
-
Are additional uokw to be seed?
How mama? I I What is the height of the additional es?
6c.
Are any pules to be modified/rebuilt/replaced? If yes:
How titan ? I I What LS the height of the poles alter?
Describe the modification rebuild:
SECTION C
Control and
coniml and public safety shall he in-acvordance with City
required by the City Engineer. Every Q:ugger must be trained as required by WAC 296-iaj-3oS and must have
certification verifying completion of the required training in their pass mion.
Restoration Restoration shall be in accordance with City codex :end StandAds. All street cut trench work -shall be
patched with asphalt or City approved mat rial prhn to the end of the workday --.CIO FACE IMONS
1 nh-uranee. The City may n►yuhr the owner or contractor to provide proof of insurance aemptable to the City prior to
any permit upprovilt .
lndemnification. l'he Applicant agrees to defend, indemnify, and hold hannle the City n( F,dmr•ndz, its officials.
officers, employees, and agents against any injuries, damages, ter claims of any kind or description whatsoever,
foreseen or unforeseen, including defense Lva;ts and attorney fees, resulting directly or indirec:th• from any act or
omission of the Applicant, its-sulwontmetous, anyone directly or hulimeth• cmploy� d by them, and anyone for whose
acts or omissions4hey 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 adeipsately perform, in any
respect, all authorizatiom or obligations under the permit. These indemnification requimmentr shall :survive the
expiration, revmation, or termination of any resulting permit approval.
Acceptance of terms, conditions, and requirements. Applicant accepts the terms, conditions, and
requirements set forth in thisApplicttion and agrees they; pply'to any resulting permit and shall comply with thein to
the satisfaction of the City Engineer. Applicant further agrees to comply with the conditions Wed on the Submittal
Requirements; with all applicable city oniinancm, including but not limited to 1•;CI)c -role eft; and with all applicable
requirementa.ofttate and federal law.
Statement of Applieant. I declarr under penalty of perjury under the laws of the State of Washington that:: I am a
licensed and bonded contractor. the informatkm provided herein is corms t and complete: -and I am authorized by
owner to Act on its behalf and have authurity to ' d the owner to this application.
Fees. The Applicant is responsibl I it f
APPLICANTSIGNATURF- _ DATE: cl is 23
APPticANT PRwrED NAME:�C+ -- erT Q
ITI
APPtJCANTT.E: _
NO WORK SHALL BWIN PRIOR TO PERMIT ISSUANCE
City of Edmonds KOW constrvrtion IN -runt Appticatnon-1'39r3 of 3 Updated 3/25/2-0l1
as