HomeMy WebLinkAbout20251113_PJA25-0064_Form R yaht-of-Way P crmit A n2lication
For submittal checklist, see below.
*denotes required fields
P Ioject Information
*Project Name: IWO 00061454 to replac
*Description of Project:
D 6tribution panel replacement at Pole 168060 -
O\,erhead work in RO Wonly. Westbound lane closure
on E 3rd St. for PUD crewsto perform work. All
O\,erhead work/ No pavement/ground disturbance
Engineers Estimated C cst of C instruction; $ 122,000.00
C mtact Information
Owmr Information
*Owner Name: Snohomish County PUD
*Office No.: 425-405-1520
*Email Address: txgash@snopud.com
*C dl No.: 425-530-6141
*Mailing Address: IPO Box 1107
*C ty: Everett
*State: WA
*Zip: 98206
E igineer Information
Engineer Name: ILucas H tterdal- Sno PUI
Office No.: 425-308-1857
Email Address: Ixhitte@snopud.com
C dl No.: 425-308-1857
Mailing Address: IPO Box 1107
C ty: Everett
State: IWA
Zip: 198206
Professional License
Number:
Expiration D zte:
C cntractor Details
Primary C mtractor: Snohomish County PUD
Office No.: 425-405-1520
Email Address: txgash@snopud.com
C dl No.: 425-530-6141
Mailing Address: IPO Box 1107
C ty: Everett
State: IWA
Zip: 198206
L&I C mtractor N/A
License Number:
Expiration D Ete:
A cknowledgement
I, hereby certify that I have read and examined this application, Cty of Arlington Municipal C ale, Standard Plan &
Specifications. Performance of the proposed work shall follow all applicable laws and regulations. The owner/applicant
shall assume full and complete responsibility for said work and shall be responsible for the acquisition and compliance
of all applicable permits and/or authorizations which may include,but not limited to, R#ht of Way Permit, WSDW
Hydraulic Project Approval(HPA), WSD OENotice of Intent(NOS National Pollutant Dscharge Elimination System
(NPDES),Army Corp. of Engineers Permits, the requirements of the Endangered Species Act, and the Forest Practices
Application (FPA).
*P rint Name: ITeresa G a6h *Date: 2025-11-12
Submittal C becklist
Canplete package constitutes all items. Only complete submittals wf71 be accepted.
Electronic files shall be PD Fand submitted through this portal, email or downloadable link to file server.
• C instruction Plans; refer to D esign R Muirements and C lapter 1 of the C ty of Arlington's D esign and C instruction
Standards and Specifications Manual for required sheets.
• Traffic C introl Plan.
• R cad Closure R equest.
• Temporary Erosion & Sediment C introl (TESC)Plan if new or replaced hard surfacing is being constructed.
• C ertificate of Insurance with the C ty of Arlington named as Additional Insured.
P ermit fee and any assurarnce device (B and or Assignment of Funds) due at time of permit
issuance. An invoice with link for payment will be sent to the applicant email address once
permit is reviewed and approved.