ENG20170014.pdfcry I' ta,t�
CITY OF
EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20170014
RIGHT OF WAYPERMIT (6-EIJC)
Permit Number: ENG20170014 Expiration Date: 07/27/2017
Job Address: 23926 74TH AVE W, EDMONDS Location: 23926 74TH AVE W
APPLICANT
PSF/Infrasource
CONTRACTOR
PSE/Infrasource
GO Susan att: Sidick
C/O Susan att: Sidick
1660 Park Lane
1660 Park Lane
Burlington, WA 98233
Burlington, WA 98233
(425)457-6353
LICENSE #: infrasl871c2 EXP: 02/22/2017
Emergency gas leak repair follow up permit. Cross bore through sewer. 1 3x5 paving cut work has been completed.
,,x.61 SSED VALUE: $0 00 PROPERTY AREA: 0
IIIIWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0,00 STREET DISRUPTION TRENCH CUT: ( 3 X 5 )
ARKING: ( 0X0 ) DURATION IN MONTHS: 0 FEE: $0,00 YEAR OF OVERLAY: 0 FEE: $0 00
L.LFY; I' OXO I 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
attorney fees by reason ofgranting this permit.
THECONTRACTOR IS RESPONSIBLEFOR WORKMANSHIP AND MATERIALS FOR A PERIOD OFONEYEAR FOLLOWING THEFINAL
INSPECTION AND ACCEPTANCE OF 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 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 prior to the end of the workday -NO EXCEPTIONS.
• Three sets of construction drawings of proposed work are required with the permit application.
CALL DIALrA-DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION 1A'1*';QUESTS
THIS APPLICATION IS NOTA PERMITUN IL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED.
Printe& Fiiday. Jantiary 27.201'
CG��i;ttr'�ra Wa I!anal 1/27/2-017
RELEASED BY DATE
❑ FILE COPY ❑ INSPECTOR COPY 0 APPLICANT COPY
STATUS: ISSUED
ENG20170014
• Restore ROW to City standards
• Restore Landscape to Gke or better conditions.
• Call for locates of underground utilities prior to any excavation.
• Alert affected residents and/or businesses prior to work start.
• 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.
• 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 of construction activity are exempt fromthe noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 6:00pmon weekdays and 10:00am and 6:00pm on Saturdays, excluding
Sundays and Federal Holidays. At all othertimes the noise originating from construction sites/activities must comply with the
noise limits of Chapter 530, 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 fromthe issuance ofthis permit. Issuance ofthis pen -nit 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.
INSPECTIONS
• 11Engineering Final
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: _ ------ INITIAL NOTES:—— ....
FINAL INSPECTION APPROVED DATE: INITIAL:
" Or E t,7p�0
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t
9 1117 NO..: ENCSgo
ISSUE DATE:
RIGHT-OF-WAY CONSTRUCTION
PERMIT APPLICATION
PROJECT NAME: 887033242
CONTRACTOR: PSE/Infrasource
_._ ....... ...........
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871 C2
City Business License #: NR -019840
CONTACT: Sue Sidick
Phone #: 425-457-6353
.............. ..
Fax #
Email #: Susan.Sidick@pse.com
Liability Insurance ❑ Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 23926 74th Ave W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
CommercialSubdivision City Project Traffic Control (Only)
❑ Multi -Family ❑X Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes ❑* No
ANY ASSOCIATED PERMITS? BLD# ....... _ ENG#____ ___
DESCRIPTION OF PROPOSED WORK (Be Specific) : Emergency gas leak repair follow up permit
Cross bore through sewer. 1 3x5 paving cut work has been completed
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS?YES NO Year: 8876
PAVEMENT CUT: ® Yes ❑ No If yes, indicate size of cut: 3 x 5
CONCRETE CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
RIGHT-OF-WAY DURATION
AREA TOTAL
CLOSURE (NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF X LF SF
n. . _ ..... �....-..__.. -_ . .
.�....._._._.
Alley 72 Hrs + LF � X LF SF
Parking 72 Hrs + LF X LF SF
A:VPI,-ICAI'q"F'1'0 READ AND STGN
*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
Susan S1d1C{C5=5tre1°� DATE
01/06/2017
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
PUGET
SOUND
ENERGY
Job#887033242
23926 74TH AVE W EDMONDS, WA
Z 0JANUARY 9, 2017
Sheet I of I sally. bergman@pse.com
SWM (425) 398-6003
LEGEND
LU 28' TRAFFIC CONE
10 10 BORE PIT
14 TRAFFIC FLOW
TtFLAGGER
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
23926
P
AS
Notes:
RESIDENT(S) WILL BE INFORMED 1. All signs and spacing to conform to the MUTCD
OF POSSIBLE TEMPORARY
and City of Edmonds standards.
DRIVEWAY CLOSURE
2. All sidewalks, driveways, exits and egresses shall be
completely clear unless otherwise Indicated.
3. Channelizing devices are 28" traffic cones.
4. Sign size can be a minimum of 48" x 48" and shall not
obstruct pedestrian access.
5. Crew Is required to leave a minimum of 11' for traveling
lane width.
6. Alert affected residents and businesses.
7. Work to take place between 9 a.m. and 4 p.m.
8. Work area will be APPROX. 12'WCL of 74TH AVE W &
APPROX. 268' NCL of 241ST ST SW.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
241ST ST SW p m
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