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257638 - 16404 75th PL W, Edmonds.pdf ROW PERMIT NO. : ENG___________ ISSUE DATE: ________________ RIGHT-OF-WAY CONSTRUCTION PERMIT APPLICATION PROJECT NAME: CONTACT: DPNDBTU CSFBOOBTXJGU CONTRACTOR:Phone #: 536.459.8846 QBDJGJDDBCMFDPOTUSVDUJPO Mailing Address: Fax #: 536.459.8:77 QPCPY684XPPEJOWJMMFXB:9183 Email #: State License #: CSFBOOBAQBDDBC/DPN QBDJGDD:65QK City Business License #: Liability Insurance Bonded Y Y OS.133451 ADDRESS OR INTERSECTION OF CONSTRUCTION: 16404 75TH PL W ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT: Commercial Subdivision City Project Traffic Control (Only) Multi-Family Single Family Other Y EUC (PUD, VERIZON, PSE, COMCAST, OVWSD): Is this permit part of a blanket permit? Yes No Y BLD#____________ ENG#____________ ANY ASSOCIATED PERMITS? INSTALL CATV SERVICE LINE. DESCRIPTION OF PROPOSED WORK (Be Specific) : BORE A TOTAL OF 126FT IN THE ROW. 96FT SOFT SURFACE, 30FT HARD SURFACE CROSSING 75TH _________________________________________________________________________ WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES NO Year: PAVEMENT CUT: Yes NoIf yes, indicate size of cut: _________x_________ X X CONCRETE CUT: Yes NoIf yes, indicate size of cut: _________x_________ RIGHT-OF-WAYDURATION AREATOTAL 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 anykind 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. 9-23-2017 SIGNATURE DATE Contractor or Agent NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE