ENG20170168-APPROVED PERMIT.pdft,_..1TY OFEDMONDS
121 5THAVENUENORTH;-EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20170168
Permit Number: ENG20170168 Expiration Date: 12/01/2017
Job Address: 23920 104TH AVE W, ,EDMONDS Location: 23920 104TH AVE W
APPLICANT CONTRACTOR
PSE/Infras ource P SE/I n frasowce
GO Susan att: Sidick C/O Susan att: Sidick
1660 Park Lane1660 Park Lane
Burlington, WA 98233 Burlington, WA 98233
(425)457-6353
LICENSE#:infraslg7lc2 EXP.:02/22/2019
Pemvssion ,requested to tie into existing 4" MPEIP located 12' W c/1 of 104th AV W and 2 246'N of c/1 of 240th PL SW (cut into
asphalt 6'x4') instal12" main to serve the plat ofAppleg ate Div 2 per attached drawing. 1 6x4 paving`cut anticipated.
ASSESSED' VALUE. $0,00 PROPERTY AREA„ 0
SIDEWALK: ( OXO) DURATION IN MONTHS: 0 FEE: $0,00 STREET DISRUPTION TRENCH CUT: ( 6' X 4 )
PARKING: ( OXO) DURATION IN MONTHS: 0 FEE $0,00 YEAR OF OVERLAY: 0 FEE $0,;00
ALLEY ( 0X0) DURATION IN MONTHS: 0 FEE. $0,00
1NVDEMA7TY The Applicant has signed an application which states he/she holds the City ofEdrnonds harmless from injuries,
damages or claims ofany`kind or description whatsoever, foreseen or unforeseen, that may made against the City' of Edmonds, or
any ofils 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 O'FTHEWORK.
• 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 DIAL,A-DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24' HOUR NOTICEREQUIRED FOR ALL INSPECTION' REQUESTS
SPACE PROVIDED,
Printed:' Wednesday, May 3L2017
GcJ 5 3/ Zn/7
RELEASED BY DATE
❑ FILE COPY INSPECTOR COPY APPLICANT COPY
• Restore ROW to City standards
• Restore Landscape to like 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 originatingfrom temporary' construction sites as a result of construction activity are exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on weekdays and 10:00am and 6:00pm on Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must comply with the
noise limits of Chapter 5.30, 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 from the issuance of this pen -nit. Issuance of this permit 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.
• E -Engineering Final
PARTIAL INSPECTION DATE: NOTES:
PARTIAL INSPEC71ON DATE _ INITIAL,' ,'� NOTES:
FINAL INSPECTION APPROVED' DATE.
INITIAL:
z . 0
ED ;CAN
RECEIV APR 7, 2011
APR 2 8 2017
BUILDNG ROW PERMIT NO.: ENG ( y- O�UL
ISSUE DATE:
RIGHT-OF-WAY CONSTRICTION
PERMIT APPLICATION
PROJECT NAME: 107053978
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871C2
................................�
City Business License #: N R-023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
❑ Liability Insurance ❑ Bon ....�.......����
ded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 23920 104th AVE W
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
Commercial Subdivision City Project LJ Traffic Control (Only)
❑ Multi -Family 0 Single Family ❑ Other
❑ EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? ❑ Yes W No
I ANY ASSOCIATED PERMITS? BLD#m ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) :
Permission requested to tie into existing 4" MPE IP located 12'W C/L of 104th Ave W and 2
246' N of C/L of 240th PI SW ( cut into asphalt 6'x 4') install 2" main to serve the plat of Applegate Div II per attached drawing.
1 6x4 paving cut anticipated.
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS?YES N�[U] ear:107�
PAVEMENT CUT: ® Yes ❑ No If yes, indicate size of cut: 6 x 4
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
Alley 72 Hrs + LF X LF SF
Parking 72Hrs + LF X LF SF
- - -
----- ----- ----- -----
__ J__
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 4/28/2017SIGNATURE DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
i
X
OV3HV 0 n
Ili U
p MOM V�4
OVCYB �
Q3r+v p
N Qv0d
CD 34�lnmo
r "
a
PROPOSED PVT RD
PVT RD
CHANNELIZATION
DEVICE SPACING
MPH TAPER TANGENT
55/70 40 80
35/45 30 60
25/30 20 40
0
0
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
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 betweenl a.m. and Alp.m.
8. Work area will be 12' WCL of 104th Ave W & 246' NCL of
240th PI SW.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
PVT RD
� u.
"
raruF: CD
ROAD
AHFAD
ROA
''� iV 1ViI� V�
qWORK
AHEAD�I
i4 " PEE' W, dill
10110
2401h PI SW
LEGEND
r 4=#M
28" TRAFFIC CONE
-�
�
BORE PIT
TRAFFIC FLOW
"
o
rr FLAGGER
I
WORK VEHICLE
"
W20-1
SIGN LOCATION
"
"
WARNING FLAG
m
J8-
13
I
a
A
j
8
No
Mn
� N ae gip. tx a
�r� #E
aoMA55.
ni
�.a g '
p �mg e s a��� app aha
K Ea a HE # u ` `z' ppb i
aoZM �p L -w �:, g poi
z Sed '.tea# Q6 s .`:15 $rr
p
am ma mm=<
f me p's �< Wa was
N �s IV
W ..
j#
qu
sg
w w�.
m
H spa z
o
=�##"ToWw�a
= z mo= El Is
g
�m��� 8a ��oo � a � �p .
�� " aw src w3�Gw s` u�i coi mp>E it -K g au 9��.
pm gR� o o" wwow--
55 po k" iop=
<rcmF� -o w z _ZS - Fawrn (n m wa ('j �(TS She _ N2i m �# Qfz
pa mei wg
ll a a oo z W p m
a a p p wowW =_ w� o� m n 2 2%li
�m�p��' �3<3wp y�o
n w4 m<Fw,dap�pJ t_Zdi� #Or2 0 and w mi3¢ �Z�rc
�w �r04 z� ms a O a�iip caig am OZ��= wa Zp pw� �m
mew ppU can R2 t. zj�aa C T. 3A �Oz pwwrcww o wpJ v`1¢O aw,d�w Qiw ���. aCw
w w a Rd - m# �wSp Z z N F. ES U8zo6wmF m# wYd+o vSi `#U2
= z .rig adF �n OQ yYZ Za�w #w d' Om attU§�$ so 0, �z� Stm m0 o�p3 Ugoo
a S - 2Yp5j_ aW "Z a �< w Om h^ pG�U zd r Go wa o?om wv'fLL -m wor= 4a ��` -ya No - wSaa S�oz
�LLp p _ - ¢Zd3 _ �m a > U p _ 5H��5}}} akl1NOOa �o2F'a�apyp aaU Q�JO, `o,i<�oa� i��4a
A' wa y w m x2. !i 5A m w i & U _ a� v. oa_32 Zit �aap O i�aw O O
z o y a rcz m€� Ste`=' �i o < �F s ?'pp p coi w �a� ¢w3z 4�1� z wp�Lz ¢,Q 039 v'ia "� dj Uvo
w g O iy 3w zd 3z -<o�- trip yc5. r0�� C ��qw�q mao���wprn w'� a2g �pwaUCF
_ =d �� a m a po 3m O,. ¢aH cnr, w.z A a WHO
Jia �rn v=i 4�0# aaE z¢rcAl H3 z3 ia3 GO w
b.'i na n a m m n mm a m m .. .-
' _. i — w W _ BL6LSOLOL\MJI$3'I. \al6CSW.OI i+^nJ - "m v, AM
Date of Request:
Job number
Job address:
Project mgr:.
PM email:
04/28/17
107053978
23920 104th Ave W
April Jones
april.jones@pse.com
Estimated job start date: 05/28/17
Estimated job completion date:
Citv: Edmonds Zip: 98020
PM contact #: (425) 424-6475
Description of work to be performed:
p „SSionje St t i mw "
246' N of C/L of 240th PI SW cut into asphalt 6' x 4' install 2" main to serve the plat of
Applegate Div II per attached drawing..
Pavement cut? Yes [-]No
If yes, Dimensions of Cut: Length 6' Width 4'
How many cuts? 1
Surface Type ASPHALT
Require trenching? Dyes ENO
If yes, Dimensions of trench: Length Width
Method of installation: Hole hog
Traffic impact:
Road closed
Lane closed
✓
Yes
es
7✓
No
No How Many? 1
Shoulder closed
✓
es
No
Sidewalk closed
ZYes
No
Emergency Contact: Dean Latimer
Cell Number: (253) 350-6687
Depth
Direction? East