ENG20170072-Application.pdf.,r 0 is F L" A4 (-1,
ROW PER-MlITNO.: ENG
ISSUE DATE:
RIGHT-OF-WAY T
PERMIT APPI-ACATION
PROJECT NAME - CONTRACTOR: C�� OR: P� ,€ � € �i� � ��:«�. �'� � � � .« phone., � r
Y
1
MailingAddress: �w 1 �°" ��a ' o ��� a� ' ` Fax � ' „� �. « r , i � i � Ra,
Statr, Lieense dt: 9 «
. .. LiabiNit = Insur"ance Bonded
City Business License #.-
ADDRESS
#o � ��
ADDRESS OR Ilsl'l'l;RSLC f11011q OF CONSTRUCTION:
ROW WORK ASSOCIATED N
1-1 Commercial ^ 1-1 Subdivision
�_...� Multi -Family Single Familly
�,yp�y®yryp �I/t�JppUC (l�4Jryg-1W
pp , �,�%OL1JE�.II�AW.JN, PSE,
Is this perinit part of a blanket: permit?
JE _-----_.._......._.FOLLOWING TYPE�..._...
_...............
City Project F..) Traffic Control (0111y)
D Yes 1 No
..............................
A1�15' SSC)C��4 I�17 I' v1� I S?
BLD/1--- L;NG4
DESCRIPT]ION Cil+, PROPOSED WOR (Be Specific):
_ . .......
- ..�.
w
__. k. R
SA_S STREET_CVE L_AV_E_.l_)_W.1._11'l_ly_.l_H_E__L__.A_.._ ..__F.I.._V ) IN 1� �,� El vealpa
PAVl+,Jt/lEN CUT: l YesINo if es indicate size of eut:
.............. ..__......
_.. CONCRETE CI 'l'l CUT: E.
) Yes �1 No ll�"yes, indicate size, of eute
APPLICANT—rO READ AND SIGN
. . . .... ... =� . . ...
"'Traffic control and public safety shall be in accordance Nvith City regulations as required by the City
Engineer. E'very flagger trust be trained as required by (WAC) 296...155.-305 and 111LISt have certification
verifying cornpletion of the required training in their possession,
*Restoration is to be in accordance with City codes and Standards. All sweet -cut trench work shall be
patched with asphalt or City approved n'iaterial prior to the end of the workday -- NO EXCEPTIONS.
Indemnity: The Applicant has signed an application which states helshe hold the City of
Edmonds hartriless from injuries, darnages or claims of any kind or description
whatsoever, foreseen or unforeseen, that rnay be fnade against the It of Edmonds or
any of its departments or employees, including defense costs and attorney f6estar reason
of granting this perinit.
I have read the above staternents and Understind the permit re(JUiremenis and ack n oNv ledge that I n1ust
follow all requirements in order for Clic tobe valid,
SIGNATURE . . .. .. DATE
............. I .............. . ... ------- . ................ . . . . . . . . . . ..........
Coiifiac , C6r or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCIP,
MEMO
RIGHT -OF. -WAY
DURATION
AREA
TOTAL
CLOSURE
(NUMBER OF MONTHS)
Sidewalk 48 Hrs
LF
X
LF
SF
SF
SF
MOMMMMo
Alley "i2 Hrs +
LF
x
LF
Parkin 'i2 Hrs 4-
L F
.
X
. . . .................. . ---
LF
APPLICANT—rO READ AND SIGN
. . . .... ... =� . . ...
"'Traffic control and public safety shall be in accordance Nvith City regulations as required by the City
Engineer. E'very flagger trust be trained as required by (WAC) 296...155.-305 and 111LISt have certification
verifying cornpletion of the required training in their possession,
*Restoration is to be in accordance with City codes and Standards. All sweet -cut trench work shall be
patched with asphalt or City approved n'iaterial prior to the end of the workday -- NO EXCEPTIONS.
Indemnity: The Applicant has signed an application which states helshe hold the City of
Edmonds hartriless from injuries, darnages or claims of any kind or description
whatsoever, foreseen or unforeseen, that rnay be fnade against the It of Edmonds or
any of its departments or employees, including defense costs and attorney f6estar reason
of granting this perinit.
I have read the above staternents and Understind the permit re(JUiremenis and ack n oNv ledge that I n1ust
follow all requirements in order for Clic tobe valid,
SIGNATURE . . .. .. DATE
............. I .............. . ... ------- . ................ . . . . . . . . . . ..........
Coiifiac , C6r or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCIP,
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