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OF 1'UA�
CITY OF EDMONDS
-' 121 5TH AVENUE NORTH - EDMONDS, WA 98020
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PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20130005
RIGHTOF WAY 1'ERM1'1'(7-E1JC Standard)
Permit Number: ENG20130005 Expiration Date: 03/15/2013
Job Address: 16315 75TH PL W, EDMONDS
A1311LICANT CONTRACTOR
BLACK ROCK CABLE BLACK ROCK CABLE
1512 FAIRVIEW ST 1512 FAIRVIEW ST
BELLINGHAM, WA 98229- BELLINGHAM, WA 98229-
(425) 512-8069
LICENSE #: EXP:
, DESCRIPTION
TRANSFER LINE AND REMOVE BAD POLE
Location:
DISRUPTION1
ASSESSED VALUE: $0.00 PROPERTY AREA: 0
SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0.00 STREET DISRUPTION TRENCH CUT- (OXO)
PARKING: (OXO) DURATION IN MONTHS: 0 FEE: $0.00 YEAR OF OVERLAY: 0 FEE: $0.00
ALLEY: (OXO) DURATION IN MONTHS: 0 FEE: $0.00
INDEMNITY. • The Applicant has signed an application which states he/she holds 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 but not limited to the defense of any legal proceedings including defense costs and
attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK.
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
possesion.
Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City approved
material prior to the end of the workday- NO EXCEPTIONS.
Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REQUESTS
APPLICATION1
APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed:
DATE
2013
Z
O
0
ILE COPY
❑ INSPECTOR COPY
❑ APPLICANT COPY
STATUS: ISSUED
ENG20130005
• Restore ROW to City standards
• Restore Landscape to like or better conditions.
• Call for locates of underground utilities prior to any excavation.
• Alert affected residents and/or businesses prior.to work start.
• Conform to approved working drawings and Traffic Control plan.
• Public utilities maintain 5' separation from City Utilities.
• Verify clear bore crossings
• Utility patch restoration to be in accordance with Edmonds Standard detail E2.3
• Maintain erosion & sedimentation control. Keep street clean.
• Construction hours are Monday -Friday 7am-6pm and Saturdays 10am-6pm. No work on Sundays or Federal Holidays.
• Call for required inspections as noted.
• Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way per City standards that is
caused by or occurs during the permitted project.
• Sound/Noise originating from temporary construction sites as a result of construction activity are exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00am to 6:OOpm on weekdays and 10:00am and 6:OOpm on Saturdays,
excluding Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must
comply with the noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
• Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance fo this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance not limit in any way, the City's ability to enforce any
ordinance provision.
• E-Traffic Control
• E-Engineering Final
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL: