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APPROVED ENG2024-0327 ROW PERMITRECEIVED RIGHT OT WAY CONSTRUCTION PERMIT APPLICATION Oct 30 2024 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT Complete and submit this Application in accordance with the Submittal Requirements outlined in Right -of -Way permit Handout E6s. 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 =12,11dr—m., address use Property Address at NW comer of project area:. ^ r)0 C BLD PLN ENG Owner Name of Company Franchise Ordinance No: Point of Contact Title Address City State Zip Phone Email P.M. • . M.M. _ • • • • Name of Company 60AIGP E G r Ue E: L(' • • •FMFIHMRTW•� Primary Name '5 Agent Name G "-p i,,j Z' T tle ©()(j Title © VJ V f�. Mobile O Address q S 14,57 O. Email ,_.. .i.l • State Zip �p 2� 1.1 pity tv Secondary Name Phone �OIJf �(O (P b Title Email p •c e c• one V v'P . Mobile City of Edmonas Business license No: Email State license No: C 941 ; it Contractor verifies it is currently bonded ,� Contractor verifies it currently has general liability insurance NOTE: ECDC 18.60.020 requires rnar me.epp'_'u ....:.....�.. engineer. applyType of Development —Check ALL that ❑ Multifamily residential ❑ Commercial ❑ City project o Single family residential subdivision-Aingle family -other ❑ Industrial o Demo and rebuild or from vacant land? /\ o Other, please specify: o Utility Franchise Work associated with development (check one of the above boxes as we!!1 ❑ Traffic Control Only (no associated development) City of Edmonds ROW construction permit Application --Page 1 of 3 Updated 3/25/2021 o 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.) p /� Pe "A 0-e SO UTA P q S P 11 c, j "� �/ ioGk KO(J� RIGHT-OF-WAY CLOSURE AREA TOTAL DURATION (Number of Months) Sidewalk 72 hours + LF I x I LF SF Alley 72 hours + LF I x I LF SF Parldng 72 hours + LF I x I LF SF SECTION B - If you are not a utility company performing work in the City ROW, skip to SEMON C. Type of Utility Facilities 1. The work in the right of way is on or for the following type of facilities:: o telecommunications ❑ cable ❑ power ❑ gas o water ❑ sewer ❑ storm Details of Work to be Completed 1. Does the utility owner have existing overhead infrastructure in the area of work? Yes No �( 2. 1 Will an a ui ment be added underground or above ground e.. pedestals, vaults etc.)? iC If Yes, describe: 3. Does the proposed work connect a lot or commercial development with utilities that serve more than one lot or commercial develo ment? 4• Does the work involve rebuilding or relocating an existing aboveground utility system which connects a lot or commercial development to an existingunderground common utilitysystem? 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 Durpose of serving a single-family residential subdivision? Details of Work to be Completed Yes No_ 6. I Does your project involve rebuilding or replacing utility equipment which currently serves more than one lot or commercial development? —777 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: / 7\ 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 existin oles? How man poles are to be removed? Are additional oles to be laced? How man ?T What is the height of the additionalpoles? 6c. 1 Are any poles to be modified/rebuilt/replaced? If yes: How many? I I What is the hei ht of the oles 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 Perin under the laws of the State of Washington that: I am a licensed and bonded contractor; the information provided rein is correct and complete; and I am authorized by owner to act on its behalf and have authority to bind the ner to this application. Fees. The Applicant is responsible for all permit fees. APPLICANT SIGNATURE: APPLICANT PRINTED APPLICANT TITLE: NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE ��ao2Lr City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 LEAVE DRIVEWAY AS IS Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way per city standards that is caused or occurs during the permitted project. OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY UTILITIES MAY REQUIRE A SEPERATE PERMIT. SITE PLAN ALL DISTURBED SOILS SHALL BE COMPOST AMENDED PER CITY OF EDMONDS STANDARD DETAIL SD-642 OR APPROVED EQUAL. OWNER/CONTRACTOR IS RESPONSIBLE FOR EROSION CONTROL AND DRAINAGE REMOVE ASPHALT HERE WITH NEAT SAW CUT AGAINST ASPHALT WALKWAY THIS AREA SHALL BE COMPOST AMENDED AND LANDSCAPED (MULCH, BARK, LOW LYING PLANTINGS, ETC) PRIOR TO FINAL ENGINEERING DIVISION .,7TED 17/30/2024 NO STORMWATER MANAGEMENT SYSTEM REQUIRED AT THIS TIME. IF NEW AND/OR REPLACED IMPERVIOUS SURFACE EQUALS 2000SQFT OR GREATER, A STORMWATER MANAGMEMENT SYSTEM MAY BE REQUIRED PER CITY CODES AND STANDARDS NVIV 4z, SIGN SPACING = X (1) RURAL ROADS & URBAN ARTERIALS 35 140 MPH 350't RURAL ROADS, URBAN ARTERIALS, 25 130 MPH 200't (2) RESIDENTIAL & BUSINESS DISTRICTS URBAN STREETS 25 MPH OR LESS 1001t (2) (1) ALL SPACING MAY BE ADJUSTED TO ACCOMMODATE INTERSECTIONS AND DRIVEWAYS. (2) THIS SPACING MAY BE REDUCED IN URBAN AREAS TO FIT ROADWAY CONDITIONS. MINIMUM SHOULDER TAPER LENGTH = 1-13 (feet) SHOULDER Posted Speed (mph) WIDTH (feet) 25 1 30 1 35 1 40 1 45 1 50 1 55 60 65 70 8' 40 40 1 60 1 90 1 - - - - - - 10' 40 60 1 90 1 90 1 _ USE A 3 DEVICES TAPER FOR SHOULDERS LESS THEN 8' KEEP ASPHALT WALKWAY OPEN OR ALLOW PEDESTRIANS TO WALK THROUGH DURING WORK. BUFFER DATA LONGITUDINAL BUFFER SPACE = B SPEED (MPH) 25 30 35 40 45 50 55 60 65 70 LENGTH (feet) 155 200 250 305 360 425 495 570 645 730 TRANSPORTABLE ATTENUATOR ROLL AHEAD DISTANCE = R HOST VEHICLE WEIGHT 9,900 TO 22,000 lbs. HOST VEHICLE WEIGHT > 22,000 lbs. < 45 MPH 45-55 MPH > 55 MPH < 45 MPH 45-55 MPH > 55 MPH 100, 123' 172' 74' 100, 150, PROTECTIVE VEHICLE (WORK VEHICLE) = R NO SPECIFIED DISTANCE REQUIRED b 4 ® ® �¢ WORK AREA x x L/3 B R 50, 48' ROAD WORK <WO>R AHEAD 48 Applicant shall repair/replace all damage to utilities or frontage OWNER/CONTRACTOR IS RESPONSIBLE FOR YYYO-1 W215 improvements in City right-of-way EROSION CONTROL AND DRAINAGE per city standards that is caused or occurs during the permitted project. CHANNELIZATION DEVICE SPACING feet MPH TAPER TANGENT 35/40 30 60 25/30 20 40 ENGINEERING DIVISION r-,r,r A" a"0TED p0 17/30/2024 RECEIVED Jun 28 2024 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT NOTES LEGEND 1. DEVICE SPACING FOR THE DOWNSTREAM TAPER SHALL BE 20'(FT). K TEMPORARY SIGN LOCATION SHOULDER CLOSURE - LOW SPEED 2. ALL SIGNS ARE BLACK ON ORANGE. O CHANNELIZING DEVICES (40 MPH OR LESS) PROTECTIVE VEHICLE NOT TO SCALE FILE NAME S:\Desi n R P& SW-SOndardsl2-Plan Sheet Libra 101-Published PSL\ TC Work Zone Traffic Control\ TC-5 Shoulder Closure - Low Speed 40 MP or Less)\TC-5.dgn Plot 1 TIME 2,59,41 PM —Tr FED.AID PROJ.NO. AmokRux Rv DATE 1/212018 Y�/� PLOTTED BY Ilddslf WAS �I/ TCS� DESIGNED BY Joe xu..ER ENTERED BY Washington State .... CHECKED BY coxTRnm x iounox xo. Department of Transportation oR PROJ. ENGR. re DATE TRAFFIC CONTROL PLAN REGIONAL ADM. REVISION DATE BY RECEIVED CITY OF EDMONDS MBuildingPermit Right -of -Way Application #1510752 - Over lay of asphalt. Jun 28 2024 Com CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT Applicant First Name Last Name Company Name Karl F. Borchardt Number Street Apartment or Suite Number E-mail Address P.O. Box 1115 chaplain10@yahoo.com City State Zip Phone Number Extension Lynnwood WA 98046-1115 (425) 954-0096 Contractor Company Name Contractor Unknown Number Street Apartment or Suite Number City State Zip Phone Number Extension State License Number License Expiration Date UBI # E-mail Address Project Location Number Street Floor Number Suite or Room Number City Zip Code County Parcel Number Associated Building Permit Number Tenant Name Additional Information (i.e. equipment location or special instructions)_ Work Location 27041900105300 Property Owner First Name Last Name or Company Name Number Street Apartment or Suite Number City State Zip Certification Statement - The applicant states: I certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further certify that I have full power and authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such application. I have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of work requires a licensed contractor to perform the work, the information will be provided prior to permit issuance. Date Submitted: 6/28/2024 Submitted By: Karl F. Borchardt Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Right -of -Way Application #1510752 - Over lay of asphalt. Project Contact Company Name: Name: Karl F. Borchardt Email: chaplain10@yahoo.com Address: P.O. Box 1115 Phone #: (425) 954-0096 Lynnwood WA 98046-1115 Project Type Activity Type Scope of Work Single Family Residential Modification Driveway Modifications Project Name: Over lay of asphalt. Description of Work: Asphalt was laid on city property between property and side walk after the driveway was finished. Project Details Impervious Surface Adding/Replacing less than 2,000 square feet of hard surface Page 2 of 2