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ENG2021-0132 ROW PERMITRIGHT OF WAY EUC PERMIT PERMIT MBER NUMBER City of • • • Ave N, Edmonds WA 98020ENG2021-0132 www.cityofedmonds.gov Description: COMCAST-INSTALL 2" SERVICE CONDUIT FROM POLE TO PROPERTY ISSUED: 07/15/2021 Address: 7320 179TH ST SW EDMONDS WA 98026-5534 EXPIRES: 01/17/2022 rmit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00473700003400 i NAME TYPE NAME ADDRESS PHONE APPLICANT COMCAST 1525 75TH ST SW, EVERETT WA 98203 (425)921-8201 CONTRACTOR SOUND DRILLING LLC , SEDRO WOOLLEY WA 98284-8309 (425)244-2303 OWNER CHRISTOFFERSON TONYA E & VINCE 7320 179TH ST SW, EDMONDS WA 98026-5534 A INFORMFEE DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $0.00 RIGHT OF WAY STANDARD - EUC PERMIT FEE $330.00 $0.00 THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW 07/15/2021 RELEASED BY // U DATE Printed: Thursday, July 15, 2021 12:31:53 PM 1 of 2 RIGHT OF WAY EUC PERMIT BER City of • • • I[ Z, C, www.cityofedmonds.•. • • CONDITIONS CONDITION TYPE Easement and/or permission from adjacent property owner is required prior to entry or work within ADJACENT PROPERTY an adjacent property. It is the owner's responsibility to repair/replace all damage of utilities or frontage improvements in DAMAGE TO FRONTAGE City right of Ways or Easements to City Standards caused by or occurring during the permitted IMPROVEMENTS project. Alert affected residents and/or businesses prior to work start. Verify clear bore crossings. ENGINEERING OTHER Restore landscape to like or better conditions. Call for required inspections as noted. ESC REQ Maintain erosion and sedimentation control per City and SWMMW standard requirements. Sound/Noise originating from 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:OOam to 6:OOpm on SOUND OR NOISE weekdays and 10:OOam and 6:OOpm 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. TRAFFIC CONTROL Traffic Control per approved plan and MUTCD. All Flaggers shall be certified. All utilities shall be located prior to any excavation. New locates shall be called for if at time of UTILITY LOCATES excavation, original locates are no longer identifiable. INSPECTIONS INSPECTION TYPE DATE RESULT COMPLETE A-1 JOB START X-2 ENGINEERING FINAL" E-7 TRAFFIC CTRL Printed: Thursday, July 15, 2021 12:31:53 PM 2 of 2 of EDM04O� ENG2021-0132 RIGHT OF WAY CONSTRUCTION PERMIT APPLICATION RESU B Complete and submit this Application in accordance with the Submittal May 12 2021 ''Vc. i 3a3 Requirements outlined in Right -of -Way permit Handout E6a. CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT If any field is not applicable to your project, write "N/A' instead of leaving blank. All fields required. Incomplete Applications will be denied. SECTION A General Info Project Name 7320 179th st Comcast drop Site Address or if no site address use Property Address at NW corner of project area: 7320 179th St SW Associated Permits: BLD PLN ENG Owner and Entity Holding applicable) Name of Company Comcast Franchise Ordinance No: Point of contact Jerdee Yvonne Title Address 1525 75th St SW City Everett state WA zip 98284 Phone EmailYvonne Jerdee@comcast.com Contractor and Authorized Agent of Owner (see note below) Name of CompanySOund Drilling LLC Contractor Contacts During Construction Primary Name Kolton Palmer Agent Name Kolton Palmer Title Owner Title Owner Mobile 425-244-2303 Address 24499 E State St Email kolton@sounddrillingllc.com CitySedro Woolley State WA Zip98284 Secondary Name Phone 425-244-2303 Title Email kolton sounddrillin llc.com Mobile City of Edmonds Business License No 604 13 8 62 1 -00 1 -000 1 Email State License No-SOUNDDL82IJf1 ZI Contractor verifies it is currently bonded Contractor verifies it currently has general liability insurance NOTE: ECDC 18.6o.o2o requires that the Application be signed by a licensed and bonded contractor unless otherwise approved by the city engineer. ❑ Multifamily residential ❑ Commercial ❑ City project ❑ Single family residential subdivision ❑ Single family -other ❑ Industrial ❑ Demo and rebuild or from vacant land? ❑ Other, please specify: ❑ Utility Franchise Work associated with development (check one of the above boxes as well ❑ Traffic Control Only (no associated development) ix Utility Franchise Work (no associated development) City of Edmonds ROW construction permit Application --Page 1 of 3 Updated 3/25/2021 Include an overall narrative description of the proposed work. Be specific and detailed: Describe infrastructure to be impacted, such as, poles, wires, conduit, utility mains, etc. Include whether this is construction, maintenance, or repair. Include description of proposed construction methods, (e.g., bores, trenches, overhead wires proposed, depth for underground utilities, etc.) RIGHT-OF-WAY CLOSURE AREA TOTAL DURATION (Number of Months) Sidewalk 72 hours + 0 LF x 0 LF 0 SF 0 Alley 72 hours + 0 LF x 0 LF 0 SF 0 Parking 72 hours + 0 LF x 0 LF 0 SF 0 SECTION B - If you are not a utility company performing work in the City ROW, skip to SECTION C. 1. The work in the right of way is on or for the following type of facilities: ❑ telecommunications 2g cable ❑ power ❑ gas ❑ water ❑ sewer ❑ storm Details of Work to be Completed 1. Does the utility owner have existing overhead infrastructure in the area of work? Yes No x 2. 1 Will any equipment be added underground or above ground (e.. pedestals, vaults, etc.)? x If yes, describe: 3. Does the proposed work connect a lot or commercial development with utilities that serve more than one lot or commercial development? x 4. Does the work involve rebuilding or relocating an existing aboveground utility system which connects a lot or commercial development to an existing underground common utility system? x 5. Does the work involve proposed additions to an aboveground utility system? If es: x Are the additions for the purpose of serving new commercial development? x Are the additions for the purpose of serving a single-family residential subdivision? x Details of Work to be Completed Yes No 6. Does your project involve rebuilding or replacing utility equipment which currently serves more than one lot or commercial development? x If yes, answer the following questions related to project area, i.e. the actual area in which the project is proposed: 6a. Does your project involve wires/cables/lines? If yes: x How many are existing? 1 0 1 How many are to be added? 1 City of Edmonds ROW construction permit Application --Page 2 of 3 Updated 3/25/2021 6b. Does your project involve poles? If yes: X How many poles are existing in the project area? What is the height of the existing poles? How many poles are to be removed? Are additional poles to be laced? How many? I I What is the height of the additionalpoles? 6c. Are any poles to be modified/rebuilt/replaced? If yes: X How many? I I What is the height of the poles after? Describe the modification rebuild: SECTION C Traffic Control and Public Safety. 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. Restoration shall 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. Insurance. The City may require the owner or contractor to provide proof of insurance acceptable to the City prior to any permit approval. Indemnification. The Applicant agrees to defend, indemnify, and hold harmless the City of Edmonds, its officials, officers, employees, and agents against any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, including defense costs and attorney fees, resulting directly or indirectly from any act or omission of the Applicant, its subcontractors, anyone directly or indirectly employed by them, and anyone for whose acts or omissions they may be liable, arising out of, related to, or by reason of the granting of this permit; and specifically including but not limited to all loss by the failure of the Applicant to fully or adequately perform, in any respect, all authorizations or obligations under the permit. These indemnification requirements shall survive the expiration, revocation, or termination of any resulting permit approval. Acceptance of terms, conditions, and requirements. Applicant accepts the terms, conditions, and requirements set forth in this Application and agrees they apply to any resulting permit and shall comply with them to the satisfaction of the City Engineer. Applicant further agrees to comply with the conditions listed on the Submittal Requirements; with all applicable city ordinances, including but not limited to ECDC Title 18; and with all applicable requirements of state and federal law. Statement of Applicant. I declare under penalty of perjury under the laws of the State of Washington that: I am a licensed and bonded contractor; the information provided herein is correct and complete; and I am authorized by owner to act on its behalf and have authority to bind the owner to this application. Fees. The Applicant is responsible for all permit fees. APPLICANT SIGNATURE: �/ DATE: APPLICANT PRINTED NAME: Kolton Palmer APPLICANT TITLE: Owner NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE 5/ 10/2021 City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 OWNER/CONTRACTOR IS RESPONSIBLE FOR EROSION CONTROL AND DRAINAGE VAN NOIlr1S w3'oc" ENGINEERING DIVISION APPROVED AS NOTED jell 07/15/2021 vv RESUB May 12 2021 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT G20-2 M — so! OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY UTILITIES MAY REQUIRE A SEPERATE PERMIT. -w- 1w SEE NOTE 4 W • 12C S►4ADOW VEHICLE REOLARE D SEE NOTE 4 w 1w — FLAGGER STATION / SEE NOTE 2 SEE NOTE 1 — W2a7 SEE I> NOTE 1 W3-s SEE SEE NOTE 9 NOTE I W24� SEE 414� NOTE 1 W?Q 1 A� " CERTIFICATE OF LIABILITY INSURANCE DATE(MY) 03/30//2021 021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jessica Hatley NAME: InsureOne -Kent PHONE (206) 859-4894 FAX (206) 859-4899 A/C No Ext : A/C, No 23830 Pacific Hwy S E-MAIL jessica.hatley@insureone.com ADDRESS: INSURERS) AFFORDING COVERAGE NAIL # Ste 104 Kent WA 98032 INSURERA: Western World Ins Co 13196 INSURED INSURER B : United Financial Casualty Co. 11770 SOUND DRILLING LLC INSURER C 24499 E STATE ST INSURER D INSURER E SEDRO WOOLLEY WA 98284 INSURER F COVERAGES CERTIFICATE NUMBER: CL2133034031 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED_ NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE OF INSURANCEAUUl INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence 1 OO,000 $ X MED EXP (Any one person) $ 5,000 Deductible: $5,000 per Claim PERSONAL& ADV INJURY $ 1,000,000 A Y GLB1000398 10/09/2020 10/09/2021 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X JECT LOC PRODUCTS-COMP/OPAGG $POLICY❑PRO 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO B OWNED SCHEDULED AUTOS ONLY AUTOS 02046368-1 10/20/2020 04/20/2021 BODILY INJURY (Per accident) $ X PROPERTYDAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY rx UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N / A E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is Additional Insured as their interest may appear in work performed by the insured on their behalf per written contract. Form CG2012 R E S U B applies. May 12 2021 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Edmonds ACCORDANCE WITH THE POLICY PROVISIONS. 121 5th Ave N AUTHORIZED REPRESENTATIVE Edmonds WA 98020 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GLB1000398 COMMERCIAL GENERAL LIABILITY CG 20 12 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: Person(s) or organization(s) where required by written contract or agreement with the Insured, executed prior to an occurrence or loss, to provide such persons or organizations with coverage afforded by this endorsement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II - Who Is An Insured is amended to include as an insured any state or governmental agency or subdivision or political subdivision shown in the Sched- ule, subject to the following provisions: 1. This insurance applies only with respect to opera- tions performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or author- ization. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations haz- ard". RESUB May 12 2021 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT CG 20 12 05 09 Copyright, Insurance Services Office, Inc., 2008 Page 1 of 1 u o' 3- 3 D ., y �. 3-3F 313E 3Q MINIMUM 5' SEPERATION -73 BETWEEN THE SEWER ° MANHOLE AND THE ��► fir" - i�v^ BORING SHALL BE REQUIRED 1- Ali 1 ,• 2 _ T 1. % _ CITY OF EDMONDS DEVELOPMENT SERVICES ENT -- � i 76 M 7t--