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APPROVED ENG2024-0497 ROW PERMITRIGHT OF WAY EUC PERMIT PERMIT NUMBER] City of Edmonds www.edmondswa.gov i Description: PSE-INSTALL TEST LEAD WIRES AND ANODES ON GAS MAIN ISSUED: 11/08/2024 Address: 1010 6TH AVE S EDMONDS WA 98020-4055 EXPIRES: 05/07/2025 Permit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 27032500212800 NAME TYPE NAME ADDRESS PHONE APPLICANT COURTNEY XIONG 6500 URSULA PL S, SEATTLE WA 98108 (206)348-0676 CONTACT PUGET SOUND ENERGY 6500 URSULA PL S, SEATTLE WA 98108 (206)348-0676 CONTRACTOR PSE/INFRASOURCE 1660 PARK LANE, BURLINGTON WA 98233 (425)466-4771 OWNER PHILIP A & BROCK KATH BORGNES 1010 6TH AVE S, EDMONDS WA 98020 FEE INFORMATION DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE - PER PERMIT $45.00 $45.00 ENG - INSPECTIONS - 4.1.24 $264.00 $264.00 ROW - STANDARD - 4.1.24 $396.00 $396.00 REQUIREMENTS REQUIREMENT TYPE NOTES TRAFFIC CONTROL 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 posession. RESTORATION Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City approved material prior to the end of the workday - No Exceptions WARRANTY The contractor is responsible for workmanship and materials for a period of one year following the final inspection and acceptance of the work. INSPECTION SCHEDULING: WWW.MYBUILDING PERMIT.COM 24 HR NOTICE REQUIRED The Applicant has signed an application which states he/she holds 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 but not limited to the defense of any legal proceedings including defense costs and attorney fees by reason of granting this permit. RELEASED BY: MAJ DATE: 11/08/2024 Printed: Friday, November 08, 2024 4:28:07 PM 1 of 2 RIGHT OF WAY EUC PERMIT PERMIT NUMBE3 City of Edmonds ,... Ave N, Edmonds WA•:020 1 i 1i• www.edmondswa.gov • • CONDITIONS CONDITION TYPE ALERT RESIDENTS ALERT AFFECTED RESIDENTS AND OR BUSINESSES PRIOR TO WORK START. It is the owner's responsibility to repair/replace all damage of utilities or frontage improvements in DAMAGE TO FRONTAGE City right of Ways or Easements to City Standards caused by or occurring during the permitted IMPROVEMENTS project. MAINTAIN EROSION AND SEDIMENTATION CONTROL PER CITY AND SWMMW STANDARD ESC REQUIREMENTS REQUIREMENTS. Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of whatever nature, arising directly or indirectly from the HOLD HARMLESS issuance for this permit. Issuance of this permit shall not be deemed to modify, waive or reduce any requirements of any City ordinance nor limit in any way the City's ability to enforce any ordinance provision. SCHEDULE REQUIRED INSPECTIONS AS NOTED THROUGH MY BUILDING PERMIT. INSPECTIONS www.mybuildingpermit.com POTHOLING VERIFY CLEAR BORE CROSSINGS. RESTORE LANDSCAPE Restore landscape to like or better conditions Sound or noise originating from temporary construction sites as a result of construction activity are exempt from the noise limits of ECC Chapter 5.30 only during the hours of 7:OOam to 6:OOpm on SOUND AND NOISE weekdays and 10:OOam and 6:OOpm on Saturdays, excluding Sundays and Federal Holidays. At all other times the noise originating from construction sites and activities must comply with the noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120. All utilities shall be located prior to any excavation. New locates shall be called for if at time of UTILITY LOCATES excavation, original locates are no longer identifiable. INSPECTIONS INSPECTION TYPE DATE RESULT COMPLETE A-1 JOB START E-7 TRAFFIC CTRL X-2 ENGINEERING FINAL** Printed: Friday, November 08, 2024 4:28:07 PM 2 of 2 Lti�y of ED%�O� ANC. 1 g90 SECTION A 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. RECEIVED Oct 24 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 109158596 - 12033534 Site Address or if no site address use Property Address at NW corner of project area: 1010 6 Ave S, Edmonds 98020 Associated Permits: BLD PLN ENG X Owner and Entity Holding Franchise(if aapplicable) Name of Company Puget Sound Energy Franchise Ordinance No: Point of Contact Courtney Xiong Title Program Maintenance Coordinator Address 6500 Ursula PI S City Seattle State WA Zip 98108 Phone 206-348-0676 Email courtney.xiong@pse.com Contractor and Authorized Agent of Owner Name of Company Puget Sound Energy (see note below) Contractor Contacts During Construction Primary Name Courtney Xiong Agent Name Courtney Xiong Title Program Maintence Coordinator Title Program Maintenance Coordinator Mobile 206-348-0676 Address 6500 Ursula PI S Email courtney.xiong@pse.com City Seattle State WA Zip 98108 Secondary Name Phone 206-348-0676 Title Email courtney.xiong@pse.com Mobile City of Edmonds Business License No: Email State License No: PUGETSE032A a Contractor verifies it is currently bonded � Contractor verifies it currently has general liability insurance NOTE: ECDC 18.6o.02o requires that the Application be signed by a licensed and bonded contractor unless otherwise approved by the city engineer. ❑ 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 X 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.) Install test lead wires and three 201b anodes on 2" stw gas main located at 1T W c/I 6 Ave S & 50' S c/1 Pine St. One soft surface dig (2'x15' 3' depth) Work duration: approx. 6-8 hours. RIGHT-OF-WAY CLOSURE AREA TOTAL DURATION (Number of Months) Sidewalk 72 hours + LF JxJ LF SF Alley 72 hours + LF JxJ F SF Parking 72 hours + LF JxJ LF SF SECTION B - If you are not a utility company performing work in the City ROW, skip to SECTION C. 1. The work in the right of way is on or for the following type of facilities: ❑ telecommunications ❑ cable ❑ power a gas ❑ water ❑ sewer ❑ storm 1. CompletedDetails of Work to be Does the utility owner have existing overhead infrastructure in the area of work? • X 2. Will any equipment be added underground or above ground (e.g. pedestals, vaults, etc.)? X If yes, describe: test lead and anodes 3. Does the proposed work connect a lot or commercial development with utilities that serve more than one lot or commercial development? X 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? X 5. Does the work involve proposed additions to an aboveground utility system? If es: X 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 • to be Completed Me 6. Does your project involve rebuilding or replacing utility equipment which currently serves more than one lot or commercial development? X 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: X How many are existing? I I How many are to be added? 6b. Does your project involve poles? If yes: X 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: X 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: C�a4bi�"� DATE: 10/23/2024 APPLICANT PRINTED NAME: Courtney xiong APPLICANT TITLE: Program Maintenance Coordinator NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM PRE -INSPECTION REPORT O� ALL Job #: 109158596 Date: 10/9/24 Address: Jurisdiction: Edmonds City / Zip: Right of Way Permit? ❑✓ YES ❑ No Customer: Est. Start Date: 11/05/24 PM / Insp: Est. Duration: 1 Day PUGS I SUUND ENERG y 10106Ave5 RECEI D Edmonds 98020 Oct 24 2024 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT CUST PHONE N MBER Courtney Xiong 206-348- 676 PHONE NUMBER WORK DESCRIPTION: Construction Method Trenchless ❑ Install test lead wires and three 201b anodes on 2" stw gas main located at 17' W c/1 6 Ave 5 Open Trench ❑ and -50' S c/I Pit®U��1 119��dAc n��i '�H��ii sll8d®IuEaf€ t approx. 6-8 hours. New Construct ❑ EROSION CONTROL ANIL) DR41NIAGE Existing El N4 17 fir - Pine St Work Location: '-50' S cll Pine ST & orSQFTk Area: f 1 T W cll 6 Ave S � _ 00 - !'' U) Dig/No Cut 2'x15' 3' Depth Kew VNER/CONTRACTOR RESPONSIBLE FOR LOCATING ON SITE UTILITIES. RELOCATION/REVISION TO ANY +' UTILITIES MAY REQUIRE A SEPERATE PERMIT. •:t .'rye,-; r i _��„ - - _.." _ -L 55 d u� ~ , 4 � - :1030� Applicant shall repair/replace all �•, damage to utilities or frontage r. improvements in City right-of-way per city standards that is caused or - RESTORATION LIMITS TO BE DETERMINED occurs during the permitted project. BY CITY ENGINEERING INSPECTOR Work Location Size of Diq Surface Type _ 'S of CL Pine St $—IL- 'W of CL 6 Ave S 2x15 Crushed Rock 'NSofCL $ 'EWofCL 'N S of CL $ 'E W of CL ❑ FLAGGERS # MPH ❑ TROLLY LINES ❑ BUS STOP # ❑ METER HOODS # ❑ OFFICERS # SPEED LIMIT ❑ TRAFFIC SIGNAL ❑ ARTERIAL ❑ NO PARKS # ❑ Commercial ❑ Altered Commercial ❑ Leak Repair Service Information ❑ Template Bar ❑ Residential ❑ Altered Residential P CP Work Diameter Meter EFV Pressure ❑ Bollards 2.5" # ❑ Multi -Family ❑ Replacement Service ❑ Pothole ❑ 5/8" ❑ 250 ❑ 1800 ❑ 6" WC El Bollards 4" # ❑ New Constr. ❑ Main Maintenance ❑ Extension ❑ 11/8" ❑ 425 ❑ 2600 ❑ 2# ❑ Stub ❑ Service Maintenance ❑ 11/4" ❑ 630 ❑ 10,000 ❑ > 5# ❑ FUEL LINE PERMIT NEEDED ❑ Extension ❑ valve Maintenance ❑ 2" ❑ 1000 Fuel Line Length: ❑ Compete Sery ❑ Cut & Cap Mtr Loc: ENGINEERING DIVISION Fuel Line Diameter: /_XrI_MUvr_U /i0 IVV 1 CU Jill ✓. rti,042 11 /07/2024 109158596/12033534 10106 Ave S, Edmonds 98020 cy x - z3a 7 .ch 65 4 t 1, C <, -CtS p;xfn 7l11VQ ., ushttps. _-,t, v iv iv om - Boogie maps I f 4 C google.com/maps/place/1010+6th+Ave-S,-Edmonds,+WA+98020//@47.802964,-122122.3748597,59m/data=!3m1! 1 e3!4m16!1 m9!3m8! 1 s0x54901 af... C: yt. cn s RECEIVED Oct 24 2024 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT TEMPORARY TRAFFIC CONTROL PLAN 9NIO71(19AW HJf10 Hl SN01103dSNl T1b' 3�f1C LEGEND ® WORK PIT ® 28" TRAFFIC CONE TRAFFIC FLOW WORK VEHICLE/ FLASHING LIGHTS SIGN LOCATION RIGHT OF WAY ROW ❑ WORK AREA OCHEVRON ARROW BOARD UNIFORMED POLICE OFFICER 7tFLAGGER do 1dS SI ANOZ MOM 2AAAANAHM add A9 11VHS NOUO�IdSNI lMJiN00 OI Notes: 1. All signs and spacing to conform to the MUTCD and City of Edmonds standards. 2. All sidewalks, driveways, exits and egresses shall be completely clear unless otherwise indicated. If indicated, use ADA compliant channelization. 3. Channelizing devices are 28" traffic cones. Use traffic drums (barrels) with steady burning Type C lights on all State Routes and Hwys. 4. Sign size can be a minimum of 36" x 36" and shall not obstruct pedestrian access. 5. Crew is required to leave a minimum of 10' for traveling lane width. 6. Alert affected residents and businesses. 7. Work to take place during approved work hours. (Generally between 9 a.m. and 4 p.m. on non -arterials and from 9 a.m. to 3 p.m. on arterials. If night time work is approved, signaling and flaggers shall conform to WAC 296-155-305. Night time work to take place between and ) 8. Work area will be Work area will be 50' S0avd3a CENTERLINE OF PINE ST AND 1T WEST OF GENT UNELio 3a OF 6TH AVE S. tMz tZ 100 9. If used, place NO -PARK signs 72 hours in advance of the day that the work is to ®d A13 33N 10. All Flagger and Downstream tapers shall be 50'-100'. tIZOZ/L0/ 6 6 4310 NOISIP ----------------------------------8a 2:: *0 mA0 0 A=� p71 ioz o�z 6-0ZM `dL-OZM r 1010 6th Ave S Edmonds WA 98020 USA SEE PROJECT NOTES AND CHARTS FOR APPROPRIATE SIGN SPACING AND TAPER LENGTHS RESIDENT(S) WILL BE INFORMED OF POSSIBLE TEMPORARY DRIVEWAY CLOSURE CHANNELIZATION DEVICE SPACING MPH TAPER TANGENT 55/70 40 80 35/45 30 60 25/30 20 40 U Q L-------------------- 11; M MINIMUM TAPER LENGTH=L (FT.) LANE WIDTH POSTED SPEED (MPH) 20 25 30 35 40 45 50 55 60 65 70 10 70 105 150 205 270 475 500 550 - - - 11 75 115 165 225 295 495 550 605 660 - - 12 80 125 180 245 320 1540 600 660 1720 780 1840 PUGET Designer: SOUND Michael Nageub ENERGY 425-424-6658 Project Address: michael.nageub@pse.con 1010 6th Ave S Edmonds, WA Puget Sound Energy Traffic Control Supervisor: Gregory Harwood Card No. ES2 000299 Card Exp. 09/30/2027 gregory.harwood@pse.com (425)424-6425 REV 10/22/2,024 0 Job # 12033534 1 OF 1 RECEIVED CITY OF EDMONDS M BuildingPermit.com Oct 24 2024 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT Right -of -Way Application #1565936 - PSE - 1010 6 Ave S, Edmonds Applicant First Name Last Name Company Name Courtney Xiong Puget Sound Energy Number Street Apartment or Suite Number E-mail Address 6500 Ursula PI S courtney.xiong@pse.com City State Zip Phone Number Extension Seattle WA 98108 (206) 348-0676 Contractor Company Name PUGET SOUND ENERGY INC Number Street Apartment or Suite Number 6500 Ursula PL S City State Zip Phone Number Extension Seattle WA 98108 (206) 716-2641 State License Number License Expiration Date UBI # E-mail Address PUGETSE032J 1 3/20/2026 179n 1 M55 courtney.xiong@pse.com Project Location Number Street Floor Number Suite or Room Number 1010 6TH AVE S City Zip Code County Parcel Number EDMONDS 98020 27032500212800 Associated Building Permit Number Tenant Name Additional Information (i.e. equipment location or special instructions)_ Work Location Property Owner First Name Last Name or Company Name Philip A & Brock Kathryn A Borgnes Number Street Apartment or Suite Number 1010 6TH AVE S City State Zip EDMONDS WA 98020 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: 10/23/2024 Submitted By: Courtney Xiong Page 1 of 2 CITY OF EDMONDS MyBuildingPermit.com Right -of -Way Application #1565936 - PSE - 1010 6 Ave S, Edmonds Project Contact Company Name: Puget Sound Energy Name: Courtney Xiong Email: courtney.xiong@pse.com Address: 6500 Ursula PI S Phone #: (206) 348-0676 Seattle WA 98108 Project Type Activity Type Scope of Work Utility Purveyor Utility Work Disturbance of Surface Project Name: PSE - 1010 6 Ave S, Edmonds Description of PSE job# 109158596 - 12033534 Install test lead wires and three 201b anodes on 2" stw Work: gas main located at 17' W c/I 6 Ave S & -50' S c/I Pine St. One soft surface dig (2'x15' 3' depth) Work duration: approx. 6-8 hours. Project Details Project Information Job Number 109158596 Page 2 of 2