100027508 Permit App.pdfJAI�—
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ROW PERMIT NO.: ENG
C) ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: t�CONTACT:
CONTRACTOR: Phon-
, ': LkZs- C) - -�'z
Mailing Address: Fax #: .-
S+Ar4'�= :S n'.' n-� 0 Email #•
:
MMNCity Business License #: Tub
El Liability Ins'urance Fl Bonded
ADDRESS OR. INTERSECTION OF CONSTRUCTION:
2
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial El Subdivision L] City Project Traffic Control (Only)
F] Multi -Family El Single Family ❑ Other
F] EUC (PUD, VERTZON, PSE,
COMCAST, OVWSD):
Is.this permit part of a blanket permit? El Yes No
ANY ASSOCIATED PERMIT BLD# ENG#'
D&SCRITTION OF PROPOSED WORK. (Be Specific):
a"D
_AJ
WAS STREET OVERLAYED WITHIN THE LAST FIVE S) YEARS? YES.0 NO,_E1 Year:
.PAVEMENT CUT: If Yes, -indicate size of
e cut:__x.
It yes, indicate size of cut:'. x
El
Yes
No
CONCRETE CUT:
0
Yes
No
RIGHT-OF-WAY
AREA
CLOSURE
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF-
X
LF..
SF
Alley, 727 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' (WAQ 296-155-305 and must have certification
verifying completion of the required training in their pa'ssession.
*Restoration is to be in accordance with City codes anStandards. All street cut trench work shall be
patched with asphalt or City approved material prior to the end of the workday — NO EXCEPTION&
Indemnity: The Applicant has signed an application which states helshe hold 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 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 ordor for the permit to be valid. ,
SIGNATURE DATE
tractor or Agent
NO WORD SHALL BEGIN PRIOR TO PERMIT ISSUANCE
ROAD
ONSTRUCTION
AHEAD
(W30' 1) SEE N❑TE 1
ONE LANE
ROAD
AHEAD
(W20-4) SEE CITE 1
(W2oo7 A) SEE NOTE 1
r�
TABLE A
SPEED
(MPH)
TAPER LENGTH
(FT)
CONE SPACING
ALONG TAPER
(FT)
OFFSET WIDTH _
10'
12,
25
100
120
25
30
150
180
30
35
200
240
35
40
270
320
40
45
450 1
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 OR EQUIPMENT.
LEGEND:
Fo CONE OR CHANNELIZING DEVICE
(SEE STD 7-14)
p { 1 -Z C)
WORK AREA
TRUCK WITH
FLASHING OR WITH
BEACON
30"
T
TAPER LENGTH
TOP (TABLE A)
I +
SEE NOTE 1
SEE NOTE 1
SEE NOTE 1
(W20-7 A)
30'
ONE LANE
ROAD
AHEAD
(W20-4)
30"
ROAD
ONSTRUCTION
AHEAD
(W20-1)
30"
f TRAFFIC CONTROL_ PLAN _
2 LANE ROADWAY: ONE LANE CLOSED WITH
ALTERNATING ONE—WAY TRAFFIC AND FLAGGERS
m, r FD- PUBLIC UTILITY DISTRICT NO.1 OF SNOHOMISH COUNTY
LOCATION 21420 96TH AVE W ED LYNNAREA
POLE No. 1055 NE1/4S 25 T 27 R 03 DATE 4/2/18 ORDER 100027508
REASON FOR WORK REPLACE DIST POLE AND INSTL ENGINEER MCALLISTER OPERATION 30/60
UG SEC RISER PED ON NEW POLE DRAFTER U.G. NO.
FOR SELECT HOMES SCALE
APPROVED
& DATE PRINTED
DATE WORK COMPLETED
FOREMAN
FEES REQ'D ❑ YES ❑ NO
PRIMARY OVERHEAD
❑ RESIDENTIAL
❑ COMMERCIAL
LEO NO.
SECONDARY OVERHEAD
NESC VIOLATIONS
BASIC FEE S
❑ NO ❑ YES (SEE NOTES)
@$ '=$
PERMITS (DATE GRANTED)
❑ TREE TRIM
❑ STATE
METER/CONV. POLE $
PRIMARY UNDERGROUND
❑ RESIDENTIAL
❑ COUNTY
❑ COMMERCIAL
❑ CITY
BASIC FEE S
❑
EASEMENTS
LEU NO.
@$ .=$
❑ REQUIRED ❑ NOT REQUIRED
SECONDARY UNDERGROUND
BASIC FEE $
DATE RELEASED
@$ 1=$
UNDERGROUND PLAT
FOREIGN CONTACTS
❑ JPN#
BASIC FEE S
FT @S _$
❑ JOINT TRENCH FRONTIER & CATV
❑ JOINT BORE FRONTIER & CATV
STREET LIGHTING
q FT.@$ =$
❑
POLE STENCILING
WORK IN RIGHT OF WAY
FROM TO
❑ PRIMARY
TAKE OFF POLE
❑ SECONDARY
PRE-CONST. REQUIRMENTS
❑ TREE TRIM ❑ PUD LOCATOR
q FT. @S '=$
MISCELLANEOUS FEES
❑ BACKHOE ❑ FLAGGING
VAULT $
❑ ONE CALL DATE
PERMIT $
No
STREET LIGHTING
$
S
❑ YES ❑ NO
S
M&R
AS -BUILT
S
GIS
TOTAL DUE S
DATE PAID
GIS QC
M&R
GIS Ph
JOINT USE
RECEIPT NO.
SERVICE ORDER NO.
LOCATION MAP PAGE
LEGEND:
O EXISTING POLE
X EXISTING POLE -TO BE REMOVED
• NEW POLE
NEW POLE TO REPLACE EXISTING POLE
DATE
SUBSTATION 5CR
CIRCUIT NO. 1283 PHASE 2
ENGR'S TEL. #
425-670-3216
ENGR'S CELL #
425-501-1254
OPOLE 1055
SET NEW POLE WEST OF EXISTING POLE AND
FRAME PER 12V101. 12V601 AND INSTL UG
SEC RISER PED ASSY 1U705. SET PED AT
BASE OF NEW POLE
RUN 55"OF 350 UG SEC TPX TO PED
XFR EXISITNG XFMR, PRI AND NEUT TO NEW POLE
STRIP TOP AND ABANDON OLD POLE
629 19611 I 9605 21412
214TH ST SW
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252510
25-3849i
11
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105
25-404173
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1054
21420
SHIEET OF
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