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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 108601031
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871 C2
City Business License #: N R-023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 7718 238th PL SW
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑iC Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
ANY ASSOCIATED PERMITS?
❑ Yes ® No
BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 246' N C/I of
78th AVE W & 14' S c/1 of 238th PL SW to cut and cap gas service please rush 1 3x5 concrete cut anticipated
WAS STREET OVERLAYED WITHIN THE LAST FIVE 5 YEARS? YES ❑ NO ❑ Year: 10861
PAVEMENT CUT:
CONCRETE CUT:
❑ Yes ❑ No
❑ Yes ❑ No
If yes, indicate size of cut: 3
If yes, indicate size of cut: —
x5
x
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.
SIGNATURE
DATE 12/18/2017
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Puget Sound Energy Gas Pre -Inspect Form
Job #:
108601031
Date:
11/14/17
Address:
7718 238TH PL SW
Jurisdiction:
Edmonds
City / zip:
Edmonds, 98026
ROW Permit:
Yes
Customer:
MARK SCHMITZ 425-508-1982
Est. Start Date:
1/8/18
PM / Inspector:
Jordan Cooper 425-623-5302
Est. Duration:
112 Day
Job Description / Scope of Work
Cut and Cap 3/4 STW-LI (1964) at Main 2" STWP IP 14' S (2816-1961) New Construction:
Construction Method
PLAT Map: 167069
t
N
Work Location
Size of Cut
Surface Type
246'
N
of CL
178TH AVE W
&
14'
S
I of CL
1238TH PL SW
3X5
C
of CL
&
of CL
Of CL
&
of CL
Service Information
Street Information
Job Type
Diameter:
0
Flaggers #:
Y
Arterial:
N
Cut & Cap
EFV:
0
Police #:
N
TCP:
Y
vucEr
SOUND ENERGY
Meter:
Speed Limit:
25
No Parks #:
y
Meter Loc:
Trolley Lines:
N
Mtr Hoods #:
N
Del Press:
Traffic Signal:
N
Bus Stop:
N
Bollards:
2.5" # 1 4" #
ADA Ramps #:1
N
Route #'s:
N
11 11
�IQ
240TH PL SW /
CHANNELIZATION
DEVICE SPACING
MPH
TAPER
TANGENT
55/70
40
80
35/45
30
60
5/30 2
20
40
RESIDENT(S) WILL BE INFORMED
OF POSSIBLE TEMPORARY
DRIVEWAY CLOSURE
LEGEND
®
28" TRAFFIC CONE
®
BORE PIT
TRAFFIC FLOW
FLAGGER
WORK VEHICLE/
FLASHING LIGHTS
SIGN LOCATION
RIGHT OF WAY
ROW ROW
PUGET
SOUND
ENERGY
JOB# 108601031
7718 238th PI SW Edmonds, WA
12/15/2017
stephen.gadke@pse.com (425) 424-6431
Sheet 1 of 1
Puget Sound Energy
Traffic Control Supervisor:
Stephen R Gadke
Card No. 010741
Exp.5/31 /2021
stephen.gadke@pse.com
(4��2¢¢5..) 424-6431
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 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 approx. 246' NCL of
78th AV W & 14' ECL of 228th PI SW.