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ENG2024-0038 APPROVED PACKET-need payment� of EDAio 4ti� tidu` INC. 1 S90 SECTION A RECEIVED RIGHT OF WAY CONSTRUCTION_ PERMIT APPLICATION Complete and submit this Application in accordance with the Submittal Requirements outlined in Right -of -Way permit Handout E63. Jan 25 2024 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT If any field is not applicable to your project, write "N/A" instead of leaving blank. All fields required. Incomplete Applications will be denied. General • Project Name IM "I I Dc. aLf &l_ Site Address or if no site address use Property Address at NW corner of project area: 101 5 wLovc s �Zo Associated Permits: BLD Z,02_4 OC) 5 e' PLN ENG Owner and Entity Holding Name of Company V w Q c c Franchise Ordinance No: Point of Contact c Sou" Titleit.vv ov kcz &�*vL-+ K^ txr Address ` 2 I w a City Q (J J State c Zip Phone 0 — ZQ% G X [� . Zq -1 Email ^ c^ _ 1 .v Contractor• • •w) Name of Company PC &% ►� G G+C*e,,, ors L is /`l.• Contractor � � Primary Name CorK ok Agent Name ®' WoL Roo e- `W Title �f�! AQ vta Title �� ` � TdV►L� iS r+• ^I-trf Mobile 20 41 Address I q 'q_Z (3 1�J �- Email City State W ip et JF' Secondary Name 1m ,ll�p�rhlr� Phone (,LOCO) 5"5,Cq — 28 y q Title Prt, i c� Advwvu-s+m4y,, Email 0t11%1 eta I IG. C, Mobile (ZO 5 6 — Z 1 y q City of Edmonds Business License No: Email State License No: PA LT— FeL 11 -4- K V Contractor verifies it is currently bonded Contractor verifies it currently has general liability insurance NOTE: ECDCi8.6o.oao requires that the Application be signed by a licensed and bonded contractor unless otherwise approved by the city engineer. Type of Development — Check ALL that apply i ❑ Multifamily residential ❑ Commercial ❑ City project ❑ Single family residential subdivision ❑ Single family -other ❑ Industrial ❑ Demo and rebuild or from vacant land? Other, please specify: C�&AMP t-cA--d�A ❑ 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 1 of 3 Updated 3/25/2021 ❑ Utility Franchise Work (no associated development) Project Description 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.) -- o-F I l0 AK RIGHT-OF-WAY CLOSURE AREA TOTAL DURATION (Number of Months) Sidewalk 72 hours + LF x LF SF Alley 72 hours + LF x LF SF Parking 72 hours + I LF x LF SF SECTION B - If you are not a utility company performing work in the City ROW, skip to SECTION C. Tyl)e of Utility Facilities 1. The work in the right of way is on or for the following type of facilities: : ❑ telecommunications ❑ cable ❑ power ❑ gas NIA water ❑ sewer ❑ storm Details of .rk to be Completed 1. I Does the utility owner have existing overhead infrastructure in the area of work? Yes 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 ves: 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. 1 Does your project involve rebuilding or replacing utility equipment than one lot or commercial development? City of Edmonds ROW construction permit Application --Page 2 of 3 currently serves more Updated 3/25/2021 NI 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 mangy• 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 mane? I I What is the height of the additionalpoles? 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 permit fees. APPLICANT SIGNATURE: APPLICANT PRINTED NAME: l Vl' V" 1 P'Y V`-' APPLICANT TITLE: Yo WAVL NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 prb'OOg2 �C4 1 �adresr: 1 opt 5+k �ve. S edm oKds � vjA 4102o • �f T y Sidew Clos, g. Si ,. Q 10 �b 'S�- �vt TRAFFIC CONTROL INSPECTION SHALL BE REQUIRED WHENEVER WORK ZONE IS SET UP .v ENGINEERING DIVISION APPROVED AS NOTED MY 02/28/2024 s � '— ESUB Wiggage Feb 09 2024 CITY OF KSCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM DEVELOPMENT EDMOERVICES r� DEPARTMENT •••• as pe41F14ckv% fob, -Je4our = Sidewalk Closure 0 = CION* Signage RECEIVED Jan 25 2024 CITY OF EDMONDS DEVELOPMENT SERVICE CERTIFICATE OF LIABILITY INSURANCE DEPARTMENT DATE(MMIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Gloria Castro NAME: Strong Family Insurance PHONE (360)812-6466 FAQ No: (360)707-7461 811 Cleveland Ave Ste 105 E-MAIL ADDRESS: Gloria@strongfamins.com Mount Vernon, WA 98273 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: unnea IVavonal Insurance L o INSURED INSURERB: Richmond National Insurance Co PACIFIC EXTERIORS LLC INSURER C : 14724 BOTHELL WAY NE INSURERD: Lake Forest Park, WA 98155 INSURER E : INSURER F : COVFRA[.FR CFRTIFICATF NIJMRFR- nOnn13R3_1A7n33 REVISION Nl1MRFR- 15 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE INSDOLSUBR POLICY NUMBER MM DDIYYYY MM/ D/YYYY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY CSC0000559 08/21/2023 08/21/2024 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR DAMAGE TO N E PREMISES (Ea occurrence) $ 100. 000 _ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY GENERAL AGGREGATE $ 1 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: $ 2,000,000 POLICY � JE O LOC _ ,PRODUCTS - COMP/OP AGG $ 2 OOO OOO $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT jEa accident) $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY RN-7-0501293 08/21/2023 ,BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ B UMBRELLA LAB X OCCUR 08/21/2024 EACH OCCURRENCE $ 2,000,000 X EXCESS LIB CLAIMS -MADE AGGREGATE $ 2,000,000 DIED RETENTION $ CSC0000559 08/21/2023 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICERIMEMBER EXCLUDED? r (Mandatory in NH) N / A 08/21/2024 X I STATUTE I I OERH Stop Gap $ 1,000,000 $ 1,000,000 E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE DEes, describe under SCRIPTION OF OPERATIONS below $ 1,000,000 E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 9 CERTIFICATE HOLDER CANCELLATION ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN EVIDENCE ONLY ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEDREPRESENTATIVE -1-' (GSC ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by GSC on 08/21/2023 at 03:40PM CITY OF EDMONDS Right -of -Way Application #1433569 - 10092 Delapaz RECEIVED MyBuitdingPermit.com ,Jan 25 2024 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT Applicant First Name Last Name Company Name Olivia Martin Pacific Exteriors LLC Number Street Apartment or Suite Number E-mail Address 14724 Bothell Way NE olivia(gD_pacificexteriorsllc.com City State Zip Phone Number Extension Seattle WA 98155 (206) 556-2849 Contractor Company Name Pacific Exteriors LLC Number Street Apartment or Suite Number 14724 Bothell Way NE City State Zip Phone Number Extension Lake Forest Park WA 98155 (206) 427-7917 (206) 877-7518 State License Number License Expiration Date UBI # E-mail Address PACIFEL917NK 3/27/2025 602652139 cord arok(cDpacificexteriorsllc.corn Project Location Number Street Floor Number Suite or Room Number 108 5TH AVE S City Zip Code County Parcel Number EDMONDS 98020 27032300403700 Associated Building Permit Number Tenant Name BLD2024-0059 Coldwell Banker Bain Additional Information (i.e. equipment location or special instructions). Work Location Property Owner First Name Last Name or Company Name David O & Susan J Earlinq Number Street Apartment or Suite Number 17511 TALBOT RD City State Zip EDMONDS WA 98020 Certification Statement - The applicant states: 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. 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: 1/25/2024 Submitted By: Olivia Martin Page 1 of 2 i CITY OF EDMONDS MyBuildingPermit.com Right -of -Way Application #1433569 - 10092 Delapaz Project Contact Company Name: Pacific Exteriors LLC Name: Cordaro King Email: cordarok@pacificexteriorsllc.com Address: 14724 Bothell Way NE Phone #: (206) 427-7917 Seattle WA 98155 Project Type Activity Type Scope of Work Nonresidential Street Use Objects Temporary in Nature Project Name: 10092 Delapaz We are residing the overhang of the Coldwell Banker Bain overhang with an identical Description of replacement. We have scheduled this to be completed in 1 business day, with a materials pile Work: obstructing the sidewalk. We will stage cones on either side of the work area and have a re-routing plan for pedestrians. There will be no other obstruction or equipment staged. Nothing is to be stored overnight. Project Details Project Information Other Project Start Proposed start date 1/31/2024 Project End Proposed end date 1/31/2024 Page 2 of 2