ENG20160430-NEW APPLICATION.pdfCITY OF EDMONDS
121 5TH A VENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
PATUS: ISSUED ENG20160430
Permit Number: ENG20160430 Expiration Date: 11/02/2017
Job Address: 10016 EDMONDS WAY, EDMONDS Location: 10016 EDMONDS WAY
APPLICANT CONTRACTOR
PSE/Infrasource ` PUGET SOUND ENERGY/CORROSION
CIO Susan Sidick Betty Frank C/O KIMBERLY HARRIS
1660 Park Lane 6500 URSULA PL S
Burlington, WA 98233 PO BOX 97034
SEATTLE, WA 98108
(206)716-2641
LICENSE #: PUGETSE032JI EXP: 03/11/2018
* Extended originalexpiration date*
Annual maintenance inspection on test sites at 4 different locations on Edmonds" Way as shown on site plan. Traffic plan provided for
different locations. Job ref#1719901,1719905,1719906,1719900. Duration 15 min each location. For PSE reference-TS's
032991,051735,051736, 032911
AS51„S5I"jD VALUE: $0.00 PROPERTY AREA'S 0
SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0;00 STREET DISRUPTION, TRENCH CUT: ( 0`X 0 )
PARKING: ( OXO) DURATION IN MONTHS: 0 FEE $0,00 YEAR OF OVERLAY: 0 FEE: $0,00
ALLEY ('OX0 1 DURATION IN MONTHS: 0 FEE: $0,00
INDEMNITY- The Applicant has signed an application which stales he/she holds the City of Edmonds harmless from injuries,
damages or claims ofany kind or description whalsoever, foreseemor 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
attorney fees by reason ofgranting this permit.
THECONTRACTOR IS+RESPONSIBLEFOR WORKMANSHIP AND MATERIALS FOR A PERIOD'OFONEYEAR FOLLOWING THEFINAL
INSPECTION AND ACCEPTANCE O F THE W ORK.
• 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 ofthe required training in their
possesion
0; 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 NO TIC EREQ UIRED FOR ALL INSPECTION REO UESTS
AnON'IS NOTA PERMITUNTIL SIGNED BY'ME'CITY ENGINEER OR HIS/HER, DEPUTY: AND FEES ARE PAID, AND, RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED,
Printed: Tuesda ,June 20i 2017
0 FILE COPY F� INS PECTOR COPY r-] APPLICANT COPY
STATUS: ISSUED
ENG20160430
• 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,
0 Conform to approved working drawings and Traffic Control plan.
• Verify clear bore crossings
• Utility patch restoration to be in accordance with Edmonds Standard detail E2.3
•'' Maintain erosion & sedimentation control. Keep street clean.
w Call for required inspections as noted.
• Traffic Control per approved plan and MUTCD. Refer to City of Edmonds traffic control requirements.
• 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 fromtemporary construction sites as a;result ofconstruction activity are exempt fromthe noise limits
of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pmon 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 ofhis 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 ofth'is permit. Issuance ofthispemut 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 -Engineering Final'
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES: ��mw
FINAL INSPECTION APPROVED DATE: INITIAL:
� O,i. EUAgy
/~�ao
RECENFO
JUN 2 () 2017
ROW PERMIT NO.: ENG
I Ib�, ,:�, ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 1785512-PSE-InspectionYearly
CONTRACTOR: Puget Sound Energy/Corrosion
g 6500 Ursula PI S, Seattle WA 9
Mailin Address: a WA 98108
State License #: PUGETSE032J1
City Business License #:
CONTACT: Betty Frank
Pllone #: 206-716-2641
.._. ........�
Fax #:
Email #: betty.frank@pse.com
Liability Insueauce *I Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 10016 Edmonds Way, Edmonds
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial Subdivision City Project Traffic Control (Only)
❑ Multi -Family ❑ Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? El_ Yes No
....._.
[ANIASSOCIATEDENG# PERMITS? BLD# - -
DESCRIPTION OF PROPOSED WORKcec
le BSpecific) on test sites at
( ) ; Annual maintenance
4 different locations on Edmonds Way as shown on site plan.
Traffic plan provided for different locations. Job ref#- 1785512,1785513,1785516,1785517
Duration 15 mins each location. For PSE reference- TS's 032991, 051735,051736,032911
+RLAYED WITHIN THE LAST FIVE (_5) YEARS?
..............
- + + + +ARS? YES NO Year:
�AS STREET OVL;..� .._..__ _....� ....._ �,... .�.
PAVEMENT CUT: ❑ Yes No If ,yes, indicate size of cut: ,
CONCRETE CUT: 0 Yes ❑ No If ,yes, indicate size of cut: X.
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.
SIGNATURES ��DATE 6/19/17
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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AHEAD
EM 4
M3AVH100t — — --------- . . . . ..... . ...................... . ...... . .......
Edmonds Way & 100 Ave W / & 98 Ave W & Edmonds Way
Job# 887033545
Perform yearly inspections at wire box and get read at 4 locations as shown on site
plan.
Duration: 15 mins at each location.
Traffic Plan provided for traffic control. Police & flagger & additional people on
site.
/c O - '
I o
Coni�orm to approved w
„� ��I;clearore�a,#
,* t�1+``Iiadr,h r�s�orat�si��
• "laiiitain t�rns�u 's
• 4"alt a�;�tluired uis�'A
+' tr S c,` t�66, F?er ,pli
+ Applicantshallrepair/r
caused by or occurs du
• Sound/Noise originatin
of ECC Chapter 5,30'o nl
Sundays grid i cdeMlH
noise limits of "(1fapter.
�. App�ioant� awn ""t.k�a��"o-f
lliti kss llae ( it of hi
wh teypr.pature arjssbj
' nio�iy-wive orrdt�ci
provision.
EsEngineering Final
PARTIAL INSPE&ION
PARTIAL INSPECTION
FINAL INSPECTION APPROVE