APPROVED ENG2025-0035 ROW PERMITOF WAY EUC PERMIT
PERMIT NUMBER
City of Edmonds
EdmondsRIGHT
:iENG2025-0035
www.edmondswa.gov i
Description: PSE - INSTALL 4 ANODES ON GAS MAIN ISSUED: 02/19/2025
Address: 7909 186TH ST SW EDMONDS WA 98020
EXPIRES: 08/18/2025
Permit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00471000000100
I 11-1411 a i
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 CHRISTOPHER MICHAEL\AMY M 7909 186TH ST SW, EDMONDS WA 98026
ARSLAIN
FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE - PER PERMIT
$49.00 $49.00
ENG - INSPECTIONS-1.1.25
$274.00 $274.00
ROW - STANDARD - 1.1.25 $411.00 $411.00
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: 02/19/2025
Printed: Wednesday, February 19, 2025 12:44:09 PM 1 of 2
RIGHT OF WAY EUC PERMIT
PERMIT NUMBE3
City of Edmonds
,...Ave
N, Edmonds WA 9:0ENG2025-0035
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
X-2 ENGINEERING FINAL**
Printed: Wednesday, February 19, 2025 12:44:09 PM 2 of 2
RECEIVED
Lti�y of EpiyO�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.
JAN 27 2025
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 109159880 - 12057971
Site Address or if no site address use Property Address at NW corner of project area: 7909 186TH ST SW
Associated Permits: BLD PLN ENG X
Owner and Entity Holding Franchise (if applicable)
Name of Company Puget Sound Energy Franchise Ordinance No:
Point of Contact Courtney Xiong
Title Program Maintenance Coordinator
Address 6500 Ursula PI S
CitySeattle
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 Xlong
Agent Name Courtney Xiong
Title Program Maintenance Coordinator
Title Program Maintenance Coordinator
Mobile 206-348-0676
Address6500 Ursula PI S
Email courtney.xiong@pse.com
City Seattle
IState 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: PUGETSE032J1
X Contractor verifies it is currently bonded
Contractor verifies it currently has general liability insurance
N01h: 1 CDC 18.60.020 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?
x Other, please specify: Anode Installation
❑ 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 4 201b anodes on 2" STW IP gas main located at 16' N c/I 186 St SW & 22' W c/1 79 PI W. Will be using a vac truck. One soft surface dig (3'x5' 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 X gas
❑ water ❑ sewer ❑ storm
1.
CompletedDetails of Work to be
Does the utility owner have existin 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: 201b 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: l�� �� DATE: 01/27/2025
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
RECEIVED
Job #: 109159880
PRE -INSPECTION REPORT Q
JAN 27 2025
Date: 1/16/25 Address:
Jurisdiction: Edmonds City / Zip:
Right of Way Permit? ❑✓ YES ❑ No Customer:
Est. Start Date: 02/26/25 PM / Insp:
Est. Duration: 1 Day
7909 186 St SW
Edmonds 98026
CITY OF EDMONDS
SERVICES DEPARTMENT
Courtney Xiong
206 348 0676
PHONE NUMBER
WORK DESCRIPTION:
Construction Method
Trenchless ❑
Install 4 201b anodes on 2" STW IP main located at 16' N c/1186
St SW & 22' W c/I 79 P1 W
Open Trench ❑
Will be using a vac truck. Work duration: approx. 6-8 hours.
New Construct 0
Existing ❑
OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING
ND
ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY
UTILITIES MAY REQUIRE A SEPERATE PERMIT.
_
OWNER/CONTRACTOR IS RESPONSIBLE FOR
EROSION CONTROL AN1 D DRAINAGE
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SGAS MAIN
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Location:
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16'Nc11186StSW&
'' 22'Wc1179PISW
R
DiglNo Cut 3'x5' 3' Depth
18 2
..,605 "
Applicant shall repair/replace all
damage to utilities or frontage
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improvements in City right-of-way
j
per city standards that is caused or
EXISTING 2" GAS MAIN i
occurs during the permitted project.
Work Location
Size of Dig
Surface Type
'N of CL 186 ST SW &-2.2, 'W of CL
79 PL SW
Crushed Rock
3x5
'N S of CL & 'E W of CL
'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 ❑✓ 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 El11/8"
❑ 425 ❑ 2600
❑ 2#
❑ Stub ❑ Service Maintenance ❑ 11/4"
❑ 630 ❑ 10,000
❑ > 5## ❑ FUEL LINE PERMIT NEEDED
❑ Extension ❑ Valve Maintenance ❑ 2"
n 1000
Fuel Line Length:
❑ Compete Sery ❑ Cut & Cap Mtr Loc:
ENGINEERING DIVISION Fuel Line Diameter:
P1r"r"rt\JV CL., /-%Q IVV 1 CLJ
✓. ,r,44,e 02/13/2025
0 P,
r7909 186th St SW.'
a- &llkNIL
2"STW IP main
1 86th St SWO
act
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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 16' N of CL 186th St
SW & 22' W of CL 79th PI SW.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
10. All Flagger and Downstream tapers shall be
50'-100'.
TEMPORARY TRAFFIC CONTROL PLAN
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OF SCHEDULED WORK DATE
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Designer:
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31 S & WUND J a b e r Tofan
9VERGY 206-406-8460
IISI IG O RJ IONS Jaber.tofan@pse.com
Project Address:
7909 186th St Edmonds WA 98026
1
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Puget Sound Energy
Traffic Gonkd Supervisor:
Jaber Tofan
Card No. ES2 000434
Cartl Exp. 0211812028
Jaber Tofan@ps. oom
RECEIVED
JAN 27 2025
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
LEGEND
WORK PIT
®
28" TRAFFIC CONE
=4>
TRAFFIC FLOW
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
ROW
❑
WORK AREA
OCHEVRON
ARROW BOARD
UNIFORMED
POLICE OFFICER
4rFLAGGER
REV
01 /27/2025 0
Job #
12057971
1 OF 1
RECEIVED
JAN 27 2025
CITY OF EDMONDS M BuildingPermit.com
CITY OF EDMONDS
Right -of -Way Application #1606112 - PSE - 7909 186 St SW, EdmondSERVICESLOPMENT DEPARTMENT
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
7909 186TH ST SW
City Zip Code County Parcel Number
EDMONDS 98020 00471000000100
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
Christopher Michaekamy Merrie Arslain
Number Street Apartment or Suite Number
7909 186TH ST SW
City State Zip
EDMONDS WA 98026
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: 1/27/2025 Submitted By: Courtney Xiong
Page 1 of 2
CITY OF EDMONDS MyBuildingPermit.com
Right -of -Way Application #1606112 - PSE - 7909 186 St SW, Edmonds
Project Contact
Company Name: Puget Sound Energy
Name: Courtney Xiong Email: courtney.xiong@pse.com
Address: 6500 Ursula PI S Phone M (206) 348-0676
Seattle WA 98108
Project Type Activity Type Scope of Work
Utility Purveyor Utility Work Disturbance of Surface
Project Name: PSE - 7909 186 St SW, Edmonds
Description of PSE Job# 109159880 - 12057971 Install 4 201b anodes on 2" STW IP main located at 16' N
Work: c/I 186 St SW & 22' W c/I 79 PI W. Will be using a vac truck. One soft surface dig (3'x5' 3'
depth) Work duration: approx. 6-8 hours.
Project Details
Project Information
Job Number
109159880
Page 2 of 2