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ROW permit Salish Pavillion.pdfROW PERMIT NO.: ENG. ISSUE DATE: 931M PROJECT NAME: CONTRACTOR: Mailing Address: Al. � fief State License #:.!�4., 4�y City Business License #: CONTACT: JL'i-vi- Phone #: x/ Fax #: Email #: < 1'r --ElLiability Insurance -ETi-onded ADDRESS OR INTERSECTION OF CONSTRUCTION: 16W WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT: Commercial n Subdivision n City Project F1 Traffic Control (Only) M Multi -Family [:] Single Family F1 EUC (PUD, VERIZON, PSE, COMCAST, OVWSD): Is this permit part of a blanket permit? I ANY ASSOCIATED PERMITS? ZYes F] No BLD#,�&:��Z'- k�l ENG# DESCRIPTION OF PROPOSED WORK (Be Specific): 1, 't WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES [J NOYear: PAVEMENT CUT: F] Yes No If yes, indicate size of cut: x CONCRETE CUT: "Q Yes FJ No If yes, indicate size of cut: x RIGHT-OF-WAY CLOSIfRE AREA TOTAL DURATION (NUMBER OF MONTHS) Sidewalk 48 Hrs + LF X 3 LF SF 4 -4 - 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. Indemnity: The Applicant has signed an application which states helshe 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 requirern order for the permA to be valid. > j SIGNATURE DATE C retractor or/Agent NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE