106336771-23135 75 PL W.PDF9f gJDAI(>
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 106336771
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871 C2
City Business License #: NR-023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 23135 75th PL W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑X Single Family
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
❑ Other
❑ Yes 0 No
ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 210' S C/1 of 75th AVE W
& 2' W - 2" E c/1 of 75th PL W 2 3x5 concrete cuts anticipated.
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year: 106:6
PAVEMENT CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
CONCRETE CUT: ® Yes ❑ No If yes, indicate size of cut: 3 x 5
RIGHT-OF-WAY
CLOSURE AREA
TOTAL
DURATION
(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 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 order for the permit to be valid.
�gaary s!�ed tri Susan smwt
SIGNATURE Susan Sldick P"� ,SW�tp�" reWs-5re"°. 2/28/2018
:20M0 3oa7.6,.� DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Job #:
106336771
Date:
2/22/18
Jurisdiction:
Edmonds
ROW Permit:
Yes
Est. Start Date:
6/18/18
Est. Duration: 1 Day
Puget Sound Energy Gas Pre -Inspect Form
Address: 23135 75TH PL W
City/zip: Edmonds, 98026
Customer: JOHN TRANG 206-227-1031
PM / inspector: jordan cooper 425-623-5302
Job Description / Scope of Work
From 2 " STW IP 2' W Pavt (68C641-1968) Run NewScat 1 1/4 PE Service 80' (30' Stub 50' Ext)To
New Construction:
No
Single Family Home and Set A630 OL 40' ROW. SEE ATTACHED CITY OF EDMONDS
UTILITY
Construction Method
MAPS (1 1/4 for future home in back of lot) Please See City Of Edmonds GIS Map
All Scat / Trenchless
PLAT Map: 162067
L E.ti.
Ai
` ®d /NG P/L A630 MSA
'Water�.
23135 75th PL W
/ [:�81ST!NG Sto,MVdater !�
• EX(,STiNG Sewer `
Manhole mark
Work Location
Size of Cut
Surface Type
210'
S
I of CL
175th Ave W
&
2'
1 W
I of CL
175th PL W
3x5
C
210'
S
I of CL
175th Ave W
&
2'
1 E
of CL
75th PL W
3x5
C
Of CL
I
&
of CL
Service Information
Street Information
Job Type
Diameter:
1-1/4" PE
Flaggers #:
Y
Arterial:
N
New Residential Svc
EFV:
1-1/4" - 2600 - 9996744
Police #:
N
TCP:
Y
PUGET
SOUND
ENERGY
Meter:
A630 T
Speed Limit:
25
No Parks #:
Y
Meter Loc:
03 - OL
Trolley Lines:
N
Mtr Hoods #:
N
Del Press:
6" W.C.
Traffic Signal:
N
Bus Stop:
N
Bollards:
1 2.5" # 4" #
ADARamps#:l
N
Route Ws:
N
Puget Sound Energy
Traffic Control SupeMsoc
Gregory Harwood
Card No. G08997
Card Exp. 08/13/2019
g regory.harwood@pse.conn
(425)424E425 _
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6
WAU
N
WORK
AHEAD
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
1
25/30
20
40
. PP11NG
,�OO'YO
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S
1' ! #23135
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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.
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 11' for
traveling lane width.
6. Alert affected residents and businesses.
7. Work to take place between 9 a.m. and 4 p.m
unless otherwise specified. All work for arterials
and major roadways will be from 9 a.m. to 3 p.m
8. Work area will be 210' SCL of 75th Ave W &
2' WCL to 2' ECL of 75th PI W.
9. If used, place NO -PARK signs 72 hours in
advance of the day that the work is to be done.
LEGEND
® 28-TRAFFIC CONE
® BORE PIT
♦j TRAFFIC FLOW
FLAGG-
WORKWHICLE
FLASHING LIGHTS
I� SIGN LOCATION
RIGHT OF WAY
- Rev RW-
9