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-{ RIGHT OF WAY CONSTRUCTION
PERMIT APPLICATION
Complete and submit this Application in accordance with the Submittal
."VC. 1,690 Requirements outlined in Right-of-W_ a)- permit Handout E6,I.
If any field is not applicable to your project, write "N/A7 instead of leaving blank.
All fields required. incomplete Applications will be denied.
SECTION A
Project Name Sharma Residence
Site Address or if no site address use Property Address at NW corner of project area: 8422 MM 3M SW
Associated Permits: BLD 2o=-0$61 I PLN I E NG
Name of CotapaW Chander Sharma Franchise ordinance No:
Point of Collect Chande, Sharma
Title propertyOwne,
Address 8422 z38th street SW
City Edmonds State WA ZiP 98026
Phone 2o68-ygyg
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Agent Name
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City of Edmonds Business License No: bo q �6ir ^O®OB
state License No:
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Contractor verities it is currently bonded
8 Contractor verifies it currently has general habclity insurance
JVUT W- Al2K:18.60.020 requvw that the Application be signed by a licensed and bonded contractor unless otherwise approved by the city
engineer.
o Multifamily residential o Commercial o City project
o Single family residential subdivision
o Demo and rebuild or from vacant land?
o Other, please specify:
jBingle family -other o Industrial
o Utility Franchise Work associated with development (check one of the above boxes as well
c3 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)
Tlr_(�Ilct 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.)
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RIGHT-OF-WAY AREA TOTAL DURATION
CLOSURE (Number of Months)
Sidewalk 72 hours + _ LF x LF SF
Alley 72 hours + LF x LF SF
Parking 72 hours + LF x LF SF
SECTION B - If you are not a utility company performing work in the City ROW, skip to SECTIONC.
1. The work in the right of way is on or for the following type of facilities:
❑ telecommunications ❑ cable ❑ power ❑ gas
❑ water ❑ sewer ❑ storm
Details of Worl- to be Completed
1. Does the utility owner have existing overhead infrastructure in the area of work?
Yes
No
2. Will anv equipment be added under -ground or above ground (e.g. pedestals. vaults, etc.)?
If ves. 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 un derk* round common utility system?
;.
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 sin le -family residential subdivision?
Does your project involve rebuilding or replacing utility equipment which currently serves more
than one lot or commercial development?
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
roiect is proosed•
6a.
Does your project involve wires/cables/lines? If yes:
How manv are existing? 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 mane poles are to be removed?
Are additional poles to be placed?
How many? -� What is the height of the additional aoles?
6e. 1 Are any poles to be modified/rebuilt/replaced? If yes:
How many? I I What is the height 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 WAG 296-155-3o5 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 land 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 'Tale 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 e ' fees.
APPLICANT SIGNATURE: DATE: 10 • f Z 2r7 �•
APPLICANT PRINTED NAME: C o p N pC-A S f rYn2'MPq--
APPLICANT TITLE: o"
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021