ENG20160340.pdf���
100, 100,
W21-7 W5-1
CHANNELIZATION
DEVICE SPACING
Notes:
1.All signs and spacing to conform tothe MUTCD
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40
80
2.All sidewalks, driveways, exits and egresses shall bo
60
25/30
20
40
/
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Jub#188573890
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Af"PE3C ED AS N01
Notes:
1.All signs and spacing to conform tothe MUTCD
and City o(Edmonds standards.
2.All sidewalks, driveways, exits and egresses shall bo
completely clear unless otherwise indicated,
3.Channo|iz|ngdevices are 28^traffic cones.
4,Sign size can baaminimumnf4O^x48''and shall not
obstruct pedestrian access.
LEGEND
5.Crew isrequired Nleave uminimvmof��fortraveling
m� 28'RAF FIC CON[
lane width,
F,11A BORF rn
8.Alert affected residents and businesses
=� fx^prmFm*
7. Work totake place between 0ami, and 1,p.m.
8.Work ueuwill bo25' ECLof10SthAveVV&21'SCLo[
&� v�nx�x/oz
228ihSiM
mowLoommw
Q.|fused, place NO -PARK signs 72hours inadvance
ofthe day that the work iu(nbodone.
WARNING FLAG
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AIJ;![5 2 3 2016
ROW PERMIT NO.: ENG.-�
)E ISSUE DATE -
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NANIE: 186573896
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
;hate License 4: INFRASL871C2
--C'-ity —Busitie-ss License 4: NR -019840
CONTAC'I'. Sue Sidick
425-457-6353
Fax
AUU ;4,3 8116
ENCJ-NEE1,flN1.',1 DIVISK)",
Email #: Susan,Sidick@pse.com
-0 6,11)ijity Insurance [:1 onded
ADDIZESS OR INTERsEcTION OF CONSTRUCTION: 22729 105 AVE W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
-----------
i—,-oject ❑ Traffic Control (Only)
Couimeti-cial F-1—Sub("Jivisoll T City Prt>jeci
0 IVIulti-Family [A Single F,"'IiIY 1:1 Othe'*
E] ruic(PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? El Yes Ek] No
ANY A�,S 0 C �IA'�F; PERMIT,?
DESCRIPTION OF PROPOSED WORK (Be Specific): Emergency follow up permit
request for damaged gas c main at the Southeast corner of intersection dion of 105th AVE W & SW 228th ST SW. Work area was approx
25'E C/1 of 105th AVE W & 21'S c/1 of 228th ST SW. Work has been completed
... ... . ......
Work done in soft surface no paving cuts.
'D WITHINTHE Y ES1❑
- NO Yeai-.- 1865
STREET' �6V LAST FIVE (5) YEARS.
PAVEMENT CILY]": -J Yes No If yes, indicate size Of cut:
CONCRETE CUT: [:1 Yes ❑ No if yes, indicate size of cut:
APPLICANT TCS READ ANIS SIGN
*q'raflic contool and public safety shall be in accordance with City regtilations as regl.lired by the City
Engineer. Every flagger must be trained as required by (WAC) 296- t55-305 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 EXCEP-RONS.
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.
1, 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 � � � �: � �� � � � � ti ��__ � �� � TATE 0�123I2016
Contraetot or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSi1ANC E