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ENG2023-0473+City_Application+9.15.2023_2.24.43_PM+3786461DocuSign Envelope ID: 22E5AFFF-E442-4DF0-83FD-FE0256A1E97E t�,tir01<� RIGHT OF WAY CONSTRUCTION PERMIT APPLICATION Complete and submit this Application in accordance with the Submittal INC. i 8V Requirements outlined in Right -of -Way permit Handout E6.,I. 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 General• Project Name 310 DALEY: ROW IMPROVEMENTS Site Address or if no site address use Property Address at NW corner of project area: 310 DALEY STREET Associated Permits: BLD SEE ATTACHED I PLN PLN2021-0074 I ENG SEE ATTACHED Owner and Entity Name of Company Holding Franchise (if applicable) HBRE INVESTMENTS Franchise Ordinance No: N/A Point of Contact AUGUSTUS BUKOWSKI Title Managing Member Address 1951 3RD AVENUE W City SEATTLE State WA Zip 98119 Phone 206.380.9989 Email AUGIE.BUKO@GMAIL.COM Contractor and Authorized Agent of Owner (see note below) Contractor Contacts During Construction Name of Company REFORM CONSTRUCTION & DEVELOPMENT, LLC Primary Name CHAD SOVIA Agent Name CHAD SOVIA Title MEMBER Title MEMBER Mobile 503.828.4279 Address PO BOX 65073 Email SEE LEFT City SHORELINE State WA Zip 98155 Secondary Name TBD Phone Title 503.828.4279 TBD Email CHAD@REFORMCONSTRUCTIONDEVELOPMENT.COM Mobile TBD City of Edmonds Business License No: TBD Email TBD State License No: REFORCD778DH X Contractor verifies it is currently bonded Contractor verifies it currently has general liability insurance NOTE: ECDC 18.6o.o2o requires that the Application be signed by a licensed and bonded contractor unless otherwise approved by the city engineer. x Multifamily residential ❑ Commercial ❑ City project ❑ Single family residential subdivision ❑ Single family -other ❑ Industrial ❑ Demo and rebuild or from vacant land? ❑ Other, please specify: ❑ 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 DocuSign Envelope ID: 22E5AFFF-E442-4DF0-83FD-FE0256A1E97E ❑ 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.) Install utility services and street frontage improvements associated with adjacent townhouse development on private property. Right-of-way work to specifically include the following: 1. Construct new concrete sidewalk, curb, gutter and curb ramp, per plans. Install street trees, per plans. 2. Construct new vehicular entrance to public alley, per plans. 3. Construct new vehicular entrance to existinq driveway, per plans. 4. Two existing water meters to remain and be reused by new development, per plans. 5. Install (2) 1" water meters and services, including (2) core taps to existing water main, per plans. 6. Install new shared side sewer and storm connection, per plans. 7. Remove existing SnoPUD utility pole and install new utility pole in the alley. Intercept existing OH services, subject to SnoPUD approval. 8. Intercept existing overhead communication services and reroute to new utility pole, subject to franchisee approval. 9. Restore Daley Street pavement through full depth asphalt and 2" HMA grind and overlay, as appropriate and per plans. 10. Restripe Daley Street to match existing, per plans. All utility work to be performed in open trenches and expected to be approximately 3-7 feet below grade. No boring proposed. RIGHT-OF-WAY CLOSURE AREA TOTAL DURATION (Number of Months) Sidewalk 72 hours + 220.5 LF X 6.80 LF 1500 SF 1.25 MONTHS (5 WEEKS) Alley 72 hours + 16.0 LF X 96.50 LF 1544 SF 1.25 MONTHS (5 WEEKS) Parking 72 hours + 100.0 LF x 8.50 LF 850 SF 1.25 MONTHS (5 WEEKS) 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 • to be CompletedNo 1. Does the utility owner have existing overhead infrastructure in the area of work? 2. 1 Will any equipment be added underground or above ground (e.. 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 es: Are the additions for the purpose of serving new commercial development? Are the additions for the purpose of serving a single-family residential subdivision? Details of Work to be Completed Yes No 6. 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 DocuSign Envelope ID: 22E5AFFF-E442-4DF0-83FD-FE0256A1E97E 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 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 existing poles? How many poles are to be removed? Are additional poles to be laced? How many? I I What is the height of the additionalpoles? 6c. Are any poles to be modified/rebuilt/replaced? If yes: How many? I I 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: Qusuafu.st�u�—SU DATE:9/15/2023 APPLICANT PRINTED NAME: Augustus Bukowski APPLICANT TITLE: Managing Member NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 DocuSign Envelope ID: 22E5AFFF-E442-4DFO-83FD-FE0256A1 E97E �T M CITIZEN DESIGN INFO (AT) COLLABORATIVECO.COM 206.535.7908 WE ARE FAMILY DESIGNING INSPIRED SPACE TO CREATE COMMUNITY September 15, 2023 Associated Permits List Project Address: 310 Daley Street Preparer/Contact: Jacob Young Contact Info: 206.535.7908 Building Permits: BLD2022-1325 BLD2022-1326 BLD2022-1328 BLD2022-1329 BLD2023-0314 Engineering Permits: EN G2023-0173 EN G2023-0174 EN G2023-0372 EN G2023-0373 EN G2023-0374 EN G2023-0375 EN G2023-0461 EN G2023-0462 EN G2023-0463 EN G2023-0464