1340_001.pdfCITY OF EDMONDS
RMIT
ITE
RIGHT OF WAY PERMIT (3-Commercial)
JOB DESCRIPTION
DISRUPTION INFORMATION
APPLICATION APPROVAL
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ROW PERMIT NO.: ENG
ISSUE DATE:
'EIVEL
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION !UN 03 2019
DL-o; Li-DPMENT SERVICES
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PROJECT NAME: l/,�,�57,� CONTACT: 1`1,
CONTRACTOR:11a r'Gl.ct� Phone #: /
Mailing Address: tFax -------
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State License #: �0I Q--1 " �� �✓ Email
City Business.License #: I °-N= 4 21� ❑ Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONS'TR UCTION: r'`P c1 Q
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Q Commercial ❑ Subdivision ❑ City Project ❑ 'Traffic Control (Only)
❑ Multi -Family ❑ Single Family ❑ Other
❑ EU(' (PUD, VERILON, PSE,
COMCAS`h, OVWSD):
l.s this permit part of a blanket permit'? ❑ Yes ❑ No
ANY ASSOCIATED PERMITS? BLD# ENG#
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DESCRIPTION OF PROPOSED WORD (Be Specitic) : 1 Yl jif %�- �� f!. rf ..�r
WAS STREET OVERLAYED WITHIN THE LAST FIVE .5 YEARS? YES NO Year:
PAVEMENT CUT: V1 Yes ❑ No If yes, indicate size of cut: _x f d
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: _x
RIGHT-OF-WAY
DURATION
AREA
TOTAL
CLOSURE
(NUMBER OF MONTHS)
Sidewalk 48 Hrs +
LF
X
LF
l CSC) SF
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Alley 72 Hrs +
LF
X
LF
SF
Parking 72 Hrs +
Lid LF
l o LF
SF
`kkin p f (LAStf
=X
r
APPLICANT TO READ AND SIGN
PARUcu'tv
*Traffic control and public safety shall be in accordance with City regulations as required by the Ci(y
Engineer. Eveiy flagger must be trained as required by (WA(.) 246-155-305 and mList 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 hermit to be valid.
SIGNATURE r .�i�--�-- -/..;= DATE `) )
Coi- sije or or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE