REVIEWED BLD2020-0894+ROW APP+5.21.2021_11.13.25_AM+2210257of E VA,rati
Lti �J.
fNC. 1 s90
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: Harris Duplex
CONTRACTOR:
CONTACT: David Harris
e #: 206-795-2009
Mailing Address: J 5 7yZ 20 Ah E d o , Fax #: 0
State License #: -LDAU1:-]- 1414 E Q Email #: harris.davidm@hotmail.com
City Business License #: Liability Insurance Bonded
ADDRESS OR IN'rERSECI'ION OF CONSTRUCTION: 21022 74th Ave W, Edmonds Wa, 98026
ROW WORD 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
ANY ASSOCIATED PERMITS? BLD# 2020-0893 ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) :
Installation of a new sanitary sewer cleanout and installation of a connection to the water main and new
water meter for proposed duplex.
WAS STREET OVERLAYED WITHIN THE LAST FIVE (S) YEARS? YES ❑ NOV Year:
PAVEMENT CUT: ® Yes ❑ No If yes, indicate size of cut: 2 x 40 water line
CONCRETE CUT: ® Yes ❑ No If yes, indicate size of cut: 2 x 2 sewer cleanout
RIGHT-OF-WAY
CLOSURE AREA
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + NSA LF
I X
LF
SF
Alley 72 I-Irs + LF
Parking 72 Hrs + LF
X
X
LF
LF
SF
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 requirementnirder for the perm -it to be valid.
SIGNATURE 1 DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE