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APPROVED-ROW PERMIT APPLICATION-1 OF EDAfo �blp Aiv189 4 ROW PERMIT NO.: ENG ISSUE DATE: RIGHT-OF-WAY CONSTRUCTION PERMIT APPLICATION PROJECT NAME:© CONTRACTOR: Mailing Address: �34ZI State License #: City Business License #: ADDRESS OR INTERSECTION OF CONSTRUCTION: CONTACT: fr FF So Phone #: do & Y3o2 �'2 0- Fax #: Email #: 7 m Liability Insurance B ded ROW WQRK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT: Commercial ❑ Subdivision ❑ City Project ❑ Traffic Control (Only) ElMulti-Family❑ Single Family ❑ Omer ❑ EUC (PUD, VERIZON, PSE, COMCAST, OVWSD): Is this permit part of a blanket permit? ❑ Yes ❑ No ANY ASSOCIATED PERMITS? BLD# ENG# DESCRIPTION OF PROPOSED WORK (Be Specific) : _ 41cy I- / 1_/e 0 r% .1 1_ WAS STREET OVERLAYED WITHIN THE LAST FIVE 5' YEARS? YES ❑ NO ❑ Year: PAVEMENT CUT: ❑ Yes �No If yes, indicate size of cut: g CONCRETE CUT: ❑ Yes XNo If yes, indicate size of cut: - x 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 follow all remof men SIGNATURE and the permit requirements and acknowledge that I must it to be valid_ DATE 1fdZO or Agent NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Place dewalk Closed' signs adjacent to construction area. Place'Sidewalk Closed Ahead' signs at nearest crosswalks. Any closures to remain overnight shall be lit and reflective; such that the fencing is visible at night. Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way / per city standards that is caused or occurs during the permitted project. ir. LN OWNER/CONTRACTOR IS RESPONSIBLE FOR EROSION CONTROL AND DRAINAGE IIIIIIIII� � A— r i ' • SW., wig]. an Siansl 4� I R tl pe� r 1 ENGINEERING DIVISION APPROVED AS NOTED � A ,�+ 08/13/2020