100022077 Permit App.pdfROW PERMIT NO.: ENG
_(o-ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: $2q C.9Ct�t-
CONTRACTOR:
Mailing Address: SOX /4
State License #: J pi�� vSsz cLv UA
City Business License #:
CONTACT: � �'Ryi �L�►\�i,5�f
-Phone #:
Fax #:
Email#' `pig �
❑ Liability Insurance ❑ Bonded
.ADDRESS OR INTERSECTION OF CONSTRUCTION: S 2,C\ ►�z, ��
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Cnmmercial ❑ 'Subdivision ❑ City project Traffic Control (Only)
❑ Multi -Family ❑ Single Family ❑ Other
❑ EUC '(PUD, VERXZON, PSE,
COMCAST, OVWSD):
Is.this permit part of a blanket permit? ❑ Yes No
[A�ASSCOCATED PERMITS? BLD# ENGV -
.... .. .....
DESCRIPTION OF PROPOSED WORK (Be Specific) :
U s:�
WAS STREET OVERLAYED WITHIN THE LAST FIVE S) YEARS? YES.❑ NO: ❑ Year:
PAVEMENT CUT: ❑ YesNo
CONCRETE CUT: ❑ Yes No
Hyes, indicate size of cut:.
If yes, indicate size of eut:
ROAD
DNSTRl1CTION
AHEAD
(W20- 1)
3o SEE NOTE 1
ONE LANE
ROAD
AHEAD
(�p,-4) SEE NOTE 1
(w230' A) SEE 1 1
T�
TABLE A
SPEED
(MPH).
TAPER LENGTH
(FT)
CONE SPACING
ALONG TAPER
(FT)
OFFSET WIDTH
10,
12,
25
100 -
120
25
30
150
190
30
35
200
240
35
40
270
320
40
45
450
540
45
NOTE:
1. DISTANCE BETWEEN SIGNS SHALL
BE 100' FOR RESIDENTIAL
STREETS (25 MPH), AND
200' FOR ARTERIAL ROADWAYS
2. FLASHING BEACON SHALL BE
INSTALLED AT EACH SIGN FOR
NIGHT-TIME USE.
3. DISTANCES MAY VARY AS APPROVED
BY THE ENGINEER.
4, FLAGGERS REQUIRED TO CONTROL
TRAFFIC WHENEVER THE CONTRACTOR
MUST INTERRUPT TRAFFIC FLOW
TO ACCESS THE WORK SITE WITH
MATERIALS ❑R EQUIPMENT.
LEGEND;
Do. CONE OR CHANNELIZING DEVICE
(SEE STD 7-14)
y
E
I �
I
I
I
I
,1.
WORK -AREA
TRUCK WITH
FLASHING ❑R WITH
BEACON
30'
TAPER LENGTH
O (TABLE A)
I +
SEE NOTE 1•
SEE NOTE 1
SEE NOTE 1
a — I KHr r U, I_LJIN I KUL FLHIN
f 2 LANE ROADWAY: ONE LANE CLOSED WITH
ALTERNATING ONE—WAY TRAFFIC AND FLAGGERS
*(W2tO07 A)
ONE LANE
ROAD
AHEAD
(w20-4)
30'
&(w,20-1)
ON
30'
_ T.
RIGHT-OF-WAY
DURATION
�E�'
TOTAL
CLOSURE
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF
X
LF
SF
Alley 72 Hrs + LF
X
LF
SF
Parking 72 Hrs + LF
X
LF
SF
APPLICANT TO READ AND SIGN
*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 is to 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.
Indemnity: The Applicant has signed an application which states he/she hold the City of
Edmonds harmless from injuries, damages or claims of any kind or description
whatsoever, foreseen or unforeseen, that maybe made against the City of Edmonds or
any of its departments or employees, including defense costs and attorney fees by reason
of granting this permit.
I have read the above statements and understand the permit requirements and acknowledge that I must
follow all requirements in order for the permit to be valid. _
SIGNATURELk� VAL DATE
CcQractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
PUBLIC UTILITY DISTRICT NO.1 OF SNOHOMISH COUNTY
LOCATION 829 CEDAR ST ED LYNNAREA
POLE NO. 163382 NW1/4S 25 T 27 R 03 DATE 9/20/17 ORDER 100022077
REASON FOR WORK INSTL UG SEC RISER PED ASSY ENGINEER MCALLISTER OPERATION 60
GAS DRAFTER U.G. NO.
SCALE
DATE WORK COMPLETED
FOREMAN
FEES REO'D ■ YES ❑ NO
PRIMARY OVERHEAD
❑ RESIDENTIAL
❑ COMMERCIAL
LEO NO.
SECONDARY OVERHEAD
BASIC FEE S
METER/CONV. POLE s
PRIMARY UNDERGROUND
❑ RESIDENTIAL
❑ COMMERCIAL
BASIC FEE $
LEU NO.
NESC VIOLATIONS
❑ NO ❑ YES (SEE NOTES)
PERMITS (DATE GRANTED)
❑ TREE TRIM
❑ STATE
❑ COUNTY
■ CITY
El
EASEMENTS
@$ _$
❑ REQUIRED ■ NOT REQUIRED
SECONDARY UNDERGROUND
BASIC FEE 8
DATE RELEASED
@$ ._$
UNDERGROUND PLAT
FOREIGN CONTACTS
BASIC FEE 8
FT.@$ '=$
❑ JPN#
❑ JOINT TRENCH FRONTIER & CATV
STREET LIGHTING
FT.@$ _$
: JOINT J30RE FRONTIER & CATV
A
POLE STENCILING
FROM TO
TAKE OFF POLE
WORK IN RIGHT OF WAY
❑ PRIMARY
❑ SECONDARY
PRE-CONST. REQUIRMENTS
❑ TREE TRIM ❑ PUD LOCATOR
❑ BACKHOE ❑ FLAGGING
❑ ONE CALL DATE
CL FT.@$ '=$
MISCELLANEOUS FEES
VAULT 8
PERMIT 8
No.
CSLER $
STREET LIGHTING
8
❑ YES ■ NO
9-
M&R
AS -BUILT
$
GIS
TOTAL DUE S
GIS QC
M&R
DATE PAID
GIS Ph
JOINT USE
RECEIPT NO.
SERVICE ORDER NO.
LOCATION MAP PAGE 454 G-6
LEGEND:
O EXISTING POLE
X EXISTING POLE -TO BE REMOVED
• NEW POLE
NEW POLE TO REPLACE EXISTING POLE
APPROVED
& DATE PRINTED
DATE
SUBSTATION WSG
CIRCUIT NO. 406 PHASE 3
ENGR'S TEL. #
425-670-3216
ENGR'S CELL #
425-501-1254
N
(:: )INSTL UG SEC RISER PED ASSY 1 U705
SET PED AS STAKED 3' N OF POLE
RUN 40' OF 350 UG SEC TPX TO PED
W/3 [4] BAR SEC CONNECTORS
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