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SEEMAP
RIGHT-OF-WAY CONSTRUCTION
Ir
PERM r APPLICATION
PROJECT' NAME: 887033140
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License 8: INFRASSL871C2
City Business License fl: NR -010840
CONTACT: Sue Sidick
PlIoue #- 425-457-6353
Fax #:
Email : Susan,Sidick@pse.com
❑ Liability Insurance El Bonded
ADDRESS OR IWERsj�crION OF CONSTRUCTION: 1022 Spruce St
LROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Ll city P,-oject Traffic Control (Only)
M—Commerciat 0 Subdivision
[j Multi -Family LX] Single Family D Other
[I EEC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? F] Yes No
LANA'A-'S�0C,IA�--rl,'RPERMI-'I'S? i� BID# EN G H
DESCRIPTION OF PROPOSED WORK (Be Specific): Investigate and repair leak on main at approx.
12's c/I of Spruce ST & 321'W c/I of 96th AVE W. 1 3x5 paving cut anticipated.
WAS STREETOVERLAYED WITHIN THE 1,AS'.I'F.fVE (5) YEARS? YES El NO El Year-: 887b
PAVEMENTCUT: ®fires El No It, ves, indicate size of cut: 3 ------- --X 5
CONCWTE CUT: F1 Yes [:1 No Ifyes, indicate size of cut: x—
RIGHT-OF-WAY DURATION
ARIDA TOTAL
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 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 permit to be valid.
IN n UWA.- ," : 10/07/2016
Susan Sidick �� s�,�.o, �e:Sa.tH,.d,_su ,��
SIGNATURE �. W.SU: Iffe� _�s DATE
Dale: ]OI6 00 �O O1.5i�0 -0T00'
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE