ENG20150475.PDFCITY OF EDMONDS
121 5THAVENUENORTH-EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
�pc. 189�
*PERMIT MUST BE POSTED ON JOBSITE*
,STATUS:JSSUED ENG201504.75
RIGHT OF WAY PERMIT (6-EUC)
Pempk.. Number: ENG20150475: Expiration Date: 06/09/2016
Job Address:16000 75TH PL W, EDMONDS Location:
-APPLICANT CONTRACTOR
COMCAST OF WA, LLC Full Bore Inc:
1525 75TH AVE SW, #200 C/O Veronica Ocampo
Attn: Mike Fontenot 1546 nw 56th St
EVER ErT, WA 98203 Seattle, WA 98107
(360)922-2622
LICENSE #:<FULLBB1954DI : EXP: 04130/2017 .
DESCRIPTIONJOB
Starting at pole located south at the edge of 75th PL W, we will start trenching east approximately 9 feet at the depth to provide 36".
cover then continue north approx 9 feet. We will bore approx 10 feet then continue north approximately 22 feet then we will bore
driveway approx 14 feet then continue trenching 16 feet then go west approx 9 feet. We will be placing a 2nd PCV conduit in the
trench to provide Comcast cable at the above address.
WO# 181031
No pavement or concrete cuts.
DISRUPTION INrORMATION
ASSESSED VALUE: $0.00 PROPERTY AREA: 0
3IDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0.00, STREET DISRUPTION TRENCH=CUT: ( 0 X 0 )
'ARKING: . (OXO) DURATION IN MONTHS: 0 FEE: $0.00 YEAR OF OVERLAY: 0 FEE: $0.00
kLLEY: (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 ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorneyfees by reason ofgranting this permit.
TH E CO NTRACTO R 1S RESPO INS IBLE FO R W O RKMANS HIP AND MATERIALS FO R A PERIO D O F O NE YEAR FO LLO W ING TH,E FINAL
INSPECTION AND ACCEPTANCE OFTHEW ORIC
• 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 (WAQ 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 priorto.the end of the workday -NO EXCEPTIONS.
• Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAIrA-DIG (1-800424-5555) BEFOREANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT.1326
24 HOUWNOTICEREQUIRED FOR -ALL INSPECTION REQUESTS _
THIS APPLICATION IS NOTA PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED It
SPACE PROVIDED.
,Printed: Wednesdav, December 09, 20
M FILE COPY
INSPECTOR COPY /
-a
❑ APPLICANT COPY
STATUS: ISSUED"
EN.G201.50475
• Restore"ROW to City standards,
• Restore Landscape to like or better conditions.
• Call for locates of underground utilities priorto any excavation.
• Alert affected residents and/or businesses prior to work start.
• Conform to approved working drawings and Traffic Control plan.
• . Verify elear.bore crossings
• Utility patch restoration to be in accordance with Edmonds Standard detail E2.3
• Maintain erosion& sedimentation control. Keep street clean.
• Call for required inspections as noted.
• Traffic Control per approved plan and MUTCD. Refer to City of Edmonds traffic control requirements.
• No asphalt drive surface cuts approved with this permit.
• 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%pennitted project.
• Sound/Noise originating fromtemporary construction sites as.a result of construction activity are exempt from the noise limits
ofECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on weekdays and 10:00am and 6:00pm 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 of this permit. Issuance.of this pemut shall not be deemed to
modify, waive or reduce any requirements of any City ordinance not limit in anyway the City's ability to enforce, any ordinance
provision.
1
&Traffic Control
• &Engineering Final
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
I -
of EVA4()
ZiV6—
. 1890
ROW PERMIT NO.: ENGAO/d, 0 .117-5
ISSUE DATE:
RIGHT-O&WAY CONSTRUCTION
PERMIT APPLICATION 1301Y 2
PROJECT NAME: I w3)
CONTRACTOR: lbnyl i , toc
.,
Mailing Address: i7_5t� P[_
State License
City Business License
Z
CONTACT:
— vickv M6,o M 06,
Phone 3(00
Fax #T
Email #:
❑ Liability Insurance E] Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: IUDOD 1�2m�L j2AMQKt
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROjE0T_-___1
Ll Commercial 0 SubdivisionCity Proj6ct 71 Traffic Control (Only)
❑ Multi -Family El Single Family
EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
n Other
[__1 Yes n No
ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific): %rjjn� a* Poic- I
h V,! irrva et�!� J4
X —T_FTJ M I B AI I,
*i� -to w1of- 17PP(D), I&+. "Vic W'At b,e r4ew!5 et cow uif- I vi +-vew 1-o ftwiAt
fbWO 4- 6abi-c a f- +19— abbvif. add rah
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES 0 NO 0 Year:
PAVEMENT CUT:
F]
Yes
[ w No
CONCRETE CUT:
El
Yes
1�*j '-No
If yes, indicate size of cut: X
If yes, indicate size of cut: X
RIGHT-OF-WAY
AREA
CLOSURE
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 pen -nit to be valid.
SIGNATURE I/ V 1(, )0_Q V - � 1' 1 t � DATE 76 I
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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