ENG20170053-ROW.pdfOA 1. dt
CITY OF EDM " ONDS
121 5TH AVENUENORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
c. l)
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20170053'
Permit Number: ENG20170053 Expiration Date: 02/15/2018
Job Address: l 137 6TH AVE S, EDMONDSV, Location:
APPLICANT CONTRACTOR
SELECT HOMES INC SELECT HOMES INC
16531 13TH AVE W STE A 107 16531 13TH AVE W STE Al 07
LYNNWOOD, WA= 98037 LYNNWOOD, WA 98037;
(425)742-6044
LICENSE #. SELECHI I I OKN EXP,' 12/31 /2018
JOB DESCRIPTION
Install driveway and utilities for newsingle'family residence (demo e)asting).
DISRUPTION INFORMATION
ASAI S51:f) VALUE. $0,00 PROPERTY AREA 0
1191MWALK: (OXO) DURATION IN MONTHS:' 0 FEE" $0,00 STREET DISRUPTION TRENCH CUT" (OXO)
PARKING: ( 0X0) DURATION IN MONTHS:` 0 FEE: $0,00 YEAR OF OVERLAY:! 0 FEE. $0 00
/ALLEY: 0X0 DURATION IN MONTHS: 0 FEE;, $)1,00;
INDEMNITY The Applicant has signed an application which states he/she holds the CitylofEdmonds 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,
THE CONTRACTOR IS RFSPONSIBLEFOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THEWORK.
• Trak 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 NOTICE REQUIRED FOR ALL INSPECTION REQUESTS
APPLICATION APPROVAL
THIS APPLICATION IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUT Y: AND FEESARE PAID, AND RECETPTTS ACkNOWLEDGED IN
SPACE PROVIDED„
Printed: W d)iesda Febragny 15 2017
17
RELEASED BY DATE
E] FILE COPY E] INSPECTOR COPY XPPLICANTCOPY
IPA
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PROJECT NAME:
ROW PERMIT NO.: ENG
ISSUE DATE:
RIGHT-OF-WAY C NSTRUCTON
PERMIT APPLICATION
CONTRACTOR: w
State License #, .
City Business License #:
ADDRESS OR INTERSECTION OF CONSTRUCTION:
CONTACT:
Phone #:
Fax
Email #: Liu k `k q
ability�Ins�L__QA ranee4��ionded
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial I I Subdivision U City Project LJ Traffic Control (Only)
❑ Multi -Family W Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
❑ Yes ❑ No Job Number
ANY ASSOCIATED PERMITS BLD#� ...� mIT,
ENG#_ _.._ ._
DESCRIPTION OF PROPOSED WORK (Be Specific)
rN
WAS STREET OVERLAYED WITHIN THE LAST FIVE L51 YEARS" YES NO Year:
PAVEMENT CUT: ❑ Yes ❑ No If yes, indicate size of cut: x
CONCRETE CUT: 0 Yes ❑ No If yes, indicate size of cut: x
RIGHT-OF-WAY DURATION
AREA TOTAL
CLOSURE (NUMBER OF MONTHS)
A
RIGHT-OF-WAY
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.
LN—DF,,Ml'[:Y; 'l`hqAM1jg
a—nthas, ;ignet] an gppliMjon whi&i g �h/sh�h Id t, Li- City (,)f L','�frn
-Ntat �s hc/,, --ol)(15,
darnsaL-s or chinas of gy kind or iplign ryhal-�o2vgr,, fim-escen or untivas�gn,,
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_2rn injuries 1 9 g
!�K)Ats ftnttno by reason of graniiiiathsl2�Lrtnit
_qLr y 1�cc�j -j— . —
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.
SIGNATUREDATE
- - --- -----
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE