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ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: COMCAST
CONTRACTOR:
PACIFIC CABLE CONSTRUCTIO
Mailing Addressp0 BOX 573 WOODINVILLE WA 98072
State License #:PACIFCC954PJ
City Business License #: N R-022340
CONTACT: BREANNA SWIFT
A Phone #: 425-348-7735
Fax #: 425-348-7966
Email #: BREANNA@PACCAB.COM
—TLiability Insurance ® Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: f �( �,�� 0
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only)
❑ Multi -Family ❑ Single Family
Z EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
❑ Other
❑ Yes ❑X No
ANY ASSOCIATED PERMITS? FBI -,Dl/ _ ENG#_
DESCRIPTION OF PROPOSED WORK (Be Specific) : INSTALL CATV SERVICE LINE.
BORE A TOTAL OF 83FT IN THE ROW, 36FT SOFT SURFA
90TH AVE W & DRIVEWAY OF 24316
47FT HARD SURFACE CROSSING
WAS STREET OVERLAYED WITHIN THE LAST FIVE (S) YEARS? YES ❑ NO ❑ Year:
PAVEMENT CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
CONCRETE CUT: ❑ Yes ❑ No 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
XLF
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.
SIGNATURE al-�� Lam,
Cont actor or Agent
DATE 10-12-2016
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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