ENG20170039-APPLICATION.pdf..J OV- E0A,1f_1.
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PROJECT NAME: 106320178
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License g: INFRASL871C2
City Business License #: NR -019840
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
n Liability Insurance n Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 22004 92nd AVE W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
F] Commercial 0 Subdivision F1 City Project E] Traffic Control (Only)
F] Multi -Family X Single Family F] Other
F-1 EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? F] Yes n* No
I ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORIC. (Be Specific) : Work area is approx 100'S C/l of 220th ST SW
& 6'W & 8'W c/l of 92nd AVE W to install gas service 1 3x5 paving cut anticipated and 1 3x5 cut in dirt
anticipated
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES El NO El Year: 106b
PAVEMENT CUT: N Yes F] No If yes, indicate size of cut: -3 x 5
CONCRETE CUT: F] Yes F-1 No If yes, indicate size of cut: X_
RIGHT-OF-WAY DURATION
CLOSURE AREA Rj(NU
BER OF MONTHS)
Sidewalk 48 Hrs + LF X LFAlley 72 Hrs + LF X LFParking 72 Hrs + LF X LF
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.
Susan Sidick -6o-�,Dss
02/01/2017
P. ins
01:51
ate: ].0930 :30 -0T00'
SIGNATURE D016
DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Job #:
Date:
Jurisdiction
189/17
Edmonds
Right ofWay Permit? E ns
Est. Start Date:
Est. Duration:
Address: 22004 92nd Ave W
City /Zip: Edmonds 98020
Customer: Jared.---206227-4071
PK8/|nnp: A 8 d 425 495-44b5
Construction Method
WORK DESCRIPTION:
Open Trench
Upgrade to a 54-1-118
Scat Stub anda 55' 1-118 PLA TExtension. Set a A250 meter at 6" WC.
Trenchless
PLAT MAP:
--------- A
W
L_
220th ST SW
SCATSTUB
A250 IVISA
PLAT EXTENSION
3:
Uj
Work Location
Size of Cut
Surface T
e
VE
3x5
Dirt
FLAGGERS # 2
25 MPH
TROLLY LINES BUS STOP #
METER HOODS #
OFFICERS #
SPEED LIMIT
F1
TRAFFIC SIGNAL El ARTERIAL
El NO PARKS #
*
Commercial F1
Altered Commercial
E]
Leak Repair Service Information
Template Bar
*
Residential
Altered Residential
E]
CP Work Diameter Meter
EFV E] Bollards 2.5" #
E]
Multi -Family
Replacement Service
El
Pothole E] 5/8" 250
D 1800 F-1 Bollards 4" #
E]
New Constr. F]
Main Maintenance
Extension E] 11/8" 425
D 2600
F,_/1
Stub E]
service maintenance
F] 11/4" n 630
F] 10,000 F] FUEL LINE PERMIT NEEDED
R-1
Extension
valve maintenance
El 2" El 1000
Fuel Line Length:
El
Compete Sery
Cut & Cap
Mtr Loc:
Fuel Line Diameter:
---------'b ---
200'—J 200'
Lu
0 a �✓
a W20-19
F04
A
Of W3-4
rn
0
Notes: I
1. All signs and spacing to conform to the MUTCD
and City of Edmonds standards.
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 18' ECL of 92ND AVE W & APPROX.
100' SCL of 220TH ST SW.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
Mfr PUGET
SOUND
'
ENERGY
Job#106320178
33004 92ND AVE W
EDMONDS, WA
January 30, 2017
Sheet 1 of 2 sally.bergman@pse.com
W (425) 398-6003
0
Z
N
200'
CHANNELIZATION
DEVICE SPACING
MPH TAPER ITANGENT
55/70 40 80
35/45 30 60
25/30 20 40
LEGEND
91 28° TRAFFIC CONE
® BORE PIT
=' TRAFFIC FLOW
TtFLAGGER
WORK VEHICLE
1+ SIGN LOCATION
'
WARNING FLAG
Notes: I
1. All signs and spacing to conform to the MUTCD
and City of Edmonds standards.
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 18' ECL of 92ND AVE W & APPROX.
100' SCL of 220TH ST SW.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
Mfr PUGET
SOUND
'
ENERGY
Job#106320178
33004 92ND AVE W
EDMONDS, WA
January 30, 2017
Sheet 1 of 2 sally.bergman@pse.com
W (425) 398-6003
0
Z
N
200'
CHANNELIZATION
DEVICE SPACING
MPH TAPER ITANGENT
55/70 40 80
35/45 30 60
25/30 20 40
, UG T
SOUND
ENER G Y
Job#106320178
i 33004 92ND AVE W
EDMONDS, WA
January 30, 2017
Sheet 2 of 2 sally.bergman@pse.com
(425) 398-6003
U0, 0
Z
N GV3HV t6, tt
p MOM
avoa
WHY
b 6M
� N13No I W -OW G OZM
o0 0
220TH ST SW
0
oN �3uai
7 �l __ 200' - 200' 200'
l»' °8
Ta
zoo'— ------------ -------------- as.�Pl'--------------------------------—
-- ---
zoo --- 200
opo
w m s y
a W20-1 W20 -7A 22004 e'e,l
ami W3-4
rn
7
0 0
LEGEND
28' TRAFFIC CONE _ T
® BORE PIT
TRAFFIC FLOW
FLAGGER
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
o Q
0
0
0"IE W!E p
ar
Notes:
1. All signs and spacing to conform to the MUTCD
and City of Edmonds standards.
2. All sidewalks, driveways, exits and egresses shall be I
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 6-12' WCL of 92ND AVE W &
APPROX. 1 00'SCL of 220TH ST SW,
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done,
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80
35/45 30 60
25/30 20 40