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pln20140022.pdfof E DA J,,, INC i gc� 4 ROW PERMIT NO.: ENG ISSUE DATE: RIGHT-OF-WAY CONSTRUCTION PERMIT APPLICATION PROJECT NAME0, 4 i �a' � "� CONTACT: �y� ���� yr14 CONTRACTOR: / _ P S �L / Phone #: 2 2 -3 Z Mailing Address: p U t�} /U� y �r/i.✓�i%/ Fax #: State License #: Te&77 Email #: pe City Business License #: ❑ Liabi/lity Insurance Lff Bonded lk ADDRESS OR INTERSECTION OF CONSTRUCTION: �p�H r,• „� ,22}/ ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT: Commercial ❑ Multi -Family Subdivision ❑ Single Family ❑ EUC (PUD, VERIZON, PSE, COMCAST, OVWSD): Is this permit part of a blanket permit? City Project ❑ Other ❑ Yes ❑ No Job Number ANY ASSOCIATED PERMITS? BLD# nLNZ1>1Y dP 22 ENG# Traffic Control (Only) DESCRIPTION OF PROPOSED WORK (Be Specific) : �� p9,e Arm^ �y L4.i c./ r- f/D Z' d w, loft WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES NO Year: PAVEMENT CUT: ❑ Yes 'H�Zo 0 If yes, indicate size of cut: x CONCRETE CUT: 0 Yes 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 72 Hrs + LF X LF SF A PPLIC A T TO READ ANT c7rXT vr11 i 10 Al\lJ A71<Tl\ *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. INDEMITY: The Applicant has signed an application which states he/she hold the City of Edmonds harmless from iniuries, 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 d understand the permit requirements and acknowledge that I must follow all requirements in er or the permit to be va SIGNATURE DATE Contractor or Agent NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE