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PROJECT NAME: 106324243
CONTRACTOR: PSE/Infrasource
Mailing Address: 1660 Park Lane, Burlington, WA 98233
State License #: INFRASL871102
City Business License #: NR -023614
CONTACT: Sue Sidick
Phone #: 425-457-6353
Fax #:
Email #: Susan.Sidick@pse.com
F-1 Liability Insurance El Bonded
ADDRESS OR INTERSECTION OF CONSTRUCTION: 956 Spruce St
ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT:
❑ Commercial El Subdivision El City Project El Traffic Control (Only)
F] Multi -Family FX1 Single Family F-1 Other
F] EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit? El Yes FAI No
� ANY ASSOCIATED PERMITS? BLD# ENG#
DESCRIPTION OF PROPOSED WORK (Be Specific) : Work area is approx 40' S c/l of Spruce St
& ITW c/l of 10th PL S to install gas service 1 3x5 paving cut anticipated.
I WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES El NO El Year: 1062i
PAVEMENT CUT: X Yes F-1 No If yes, indicate size of cut: -3 x 5.
CONCRETE CUT: R Yes F-1 No If yes, indicate size of cut: X_
=RIGHT-OF-WAY DURATION
AREA a(NUMBER
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 ����= ���e�
s-5tre"°�
5/9/2017
SIGNATURE W. W16MT57M-0
DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Job#: 206324243
Date: 4/27/17 Address: 956 SPRUCE ST
Jurisdiction: Edmonds
Right of Way Permit? 2 YES [] NO
Est. Start Date: 07/03/17
Est, Duration: 8 Hours
* h)(4 I k)"if,.10 �`
City /Zip: Edmonds 98020
Customer: 206-369-0206
Construction Method
WORK DESCRIPTION:
INSTALL 25'OFI-118" PE SCA T5TUL9
AND 25'0F 1-118" PE 5CA TEXT SETA250
M514 A T
Open Trench F]
PLAT MAP: 164 067
SPRUCE ST
0 Fire Hydrant (57'from tie in)
IS =Sewer Manhole
Underground Oil Tank
tD
Ul
PL
LU 00
00
Work Location
Size of Cut
Surface Type
F] FLAGGERS # MPH
TROLLY LINES BUS STOP #
Ej METER HOODS #
E] OFFICERS # SPEED LIMIT
TRAFFIC SIGNAL ARTERIAL
[:] NO PARKS #
Q commercial n Altered Commercial
Leak Repair Service Information
El Template Bar
2] Residential n Altered Residential
CP Work Diameter Meter
EFV [:] Bollards 2.5" #
0 Multi -Family [:] Replacement Service
E]
Pothole [] 5/8" M 250
[] 1800 E] Bollards 4" #
E] New Constr. n Main Maintenance
Extension E] 11/8" E] 425
Fj 2600
Stub service maintenance
11/4,, F] 630
n 10,000 F] FUEL LINE PERMIT NEEDED
Extension valve maintenance
2" E] 1000
Fuel Line Length:
P/1 compete Sery Cut & Cap
Mtr Loc: O/R
Fuel Line Diameter:
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SPRUCE ST
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Notes:
® BORE PIT
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1. All signs and spacing to conform to the MUTCD
�j TRAFFIC FLOW
WORK
and City of Edmonds standards.
FLAGGER
AHEAD
2. All sidewalks, driveways, exits and egresses shall be
completely clear unless otherwise indicated.
WORK VEHICLE
3. Channelizing devices are 28" traffic cones.
4. Sign size can be a minimum of 48" x 48" and shall not
SIGN LOCATION
I
obstruct pedestrian access.
WARNING FLAG
5. Crew is required to leave a minimum of 11' for traveling
lane width.
6. Alert affected residents and businesses.
-------
CHANNELIZATION IGN
10TH PLS DEAD END
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7, Work to take place between 9 a.m. and 4 p.m.
DEVICE SPACING
APPROX. 345' SCL OF
I
8. Work area will be 17' WCL of 10th PI S
MPH TAPER TANGENT
SPRUCE.
& 40' SCL of Spruce St.
55n940 80
9. If used, place NO -PARK signs 72 hours in advance
35/45 30 60
of the day that the work is to be done.
25/30 1 20 1 40
PUGET
SOUND
ENERGY
Job#106324243
t -£M 956 Spruce St, Edmonds WA
dL OZM t OZM May 6, 2017
w a o o Sheet 2 of 2 stephen.gadke@pse.com
m < (425) 424-6431
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100' 00 100'
--- -- -- - -- --- - — --- — - - -- -- — - — -- - — - -- -- -- -- - ' - -- — - — - ---
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100' 1ao' 100 l SPRUCE ST
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LEGEND
28° TRAFFIC CONE
® BORE PIT
b' TRAFFIC FLOW
Fr FLAGGER
WORK VEHICLE
SIGN LOCATION
WARNING FLAG
F25/301
HANNELIZATION
EVICE SPACING
TAPER TANGENT
40 80
30 60
20 1 40
A
10TH PL S (DEAD END)
APPROX. 345' SCL OF
SPRUCE.
996#
h
Notes:
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1. All signs and spacing to conform to the MUTCD
04
and City of Edmonds standards.
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2. All sidewalks, driveways, exits and egresses shall be
cav
completely clear Unless otherwise indicated.
3. Channelizing devices are 28" traffic cones.
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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 17' ECL of 10th PI S
& 40' SCL of Spruce St.
9. If used, place NO -PARK signs 72 hours in advance
of the day that the work is to be done.
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