HomeMy WebLinkAboutMFP23000082.pdfNote: The Applicant is responsible for compliance with all codes and regulations, whether or not described in this document.
DEPARTMENT OF PUBLIC WORKS
Page 1 of 3 | Published: 10/27/2021
Transportation Division | 1055 South Grady Way, 5th Floor | Renton, WA 98057 | 425-430-7380
Website: rentonwa.gov
TRAFFIC CONTROL PLAN APPLICATION
Published: 10/27/2021
TRAFFIC CONTROL PLAN (TCP) MUST BE SUBMITTED TO PUBLIC WORKS TRANSPORTATION DIVISION
FOR REVIEW/APPROVAL AT LEAST FIVE (5) WORKING DAYS BEFORE THE DATE OF WORK.
The City of Renton requires any contractor, firm, corporation, or other public/private agency to prepare a traffic control
plan (TCP) and obtain city's approval of that plan when construction, repair, or maintenance work is to be conducted
within the city's right-of-way.
1. Fill out the Traffic Control Plan (TCP) Application form and prepare required submittal documents.
2. The following items are all required for submittal of the TCP Application:
☐Electronic Copy of the TCP Application
☐Electronic Copy of the TCP Layout, on 11” X 17” paper size format, which shall:
Include map(s) showing the location of the project and work area.
Be legible lettering and clear, contrasting, symbols of viewing or printing.
Must indicate street names, and north arrow and scale.
Types of plans required:
o Work hour plan – show all mobility impacts during construction hours.
o Non-work plan - show all mobility impacts after work hours when limited or no work is
happening in the right-of-way (ROW), if applicable.
o Changing construction phases – show construction sequence and each construction phase
change even if the traffic control is not modified, if applicable.
o Pedestrian access/detour plan, if applicable.
- Shall conform to the Washington State Traffic Control Flagger Certification handbook, by the
Evergreen Safety Council.
3. Submit Application via email to TCP@rentonwa.gov with the subject line “TCP Application – [Project Name].”
Project Name: Permit #:
Site Address:
Work Date: From _____________ To _____________ Work Time: Start ______________ End ______________
Construction Company:
Contact Name: Phone/Cell: _________________________
Business Address: City/State: Zip:
Description of Work:
Approval By: _________________________________________________ Date:____________________
Transportation Engineering
Northsky Communications
Tawnya Longfellow
22517 88th ave S Kent/WA 98031
P.066860
1415 N 24th St
2/2/23 3/2/23
425 615 7121
Lumen to remove aerial drops from pole A0501280, transfer 1 existing aerial drop to new pole,
replace Ped with new HH, and trench approx. 2’ from new HH to new pole.
Scott Warlick - CED 1/5/2023
MFP23000082
FridayMonday 8:00am 3:00pm
Note: The Applicant is responsible for compliance with all codes and regulations, whether or not described in this document.
Page 2 of 3 | Published: 10/27/2021
PERMIT HOLDER AGREES TO ALL THE FOLLOWING:
Must have approved Traffic Control Plan (TCP) prior to commencing the work.
Maintain existing pedestrian access. The work on pedestrian facilities, shall be limited to one corner at a time,
with the least possible inconvenience or delay to pedestrians.
WORK TIME begins when any street or travel lane is fully or partially closed. This includes set up within the
traveled way.
Comply with all traffic regulations of the City of Renton and the State of Washington.
Prepare a traffic control plan and obtain City approval of that plan. That plan shall be implemented for all street
and lane closures, and the plan shall be performed in compliance with the Manual on Uniform Traffic Control
Devices.
Notify emergency services (253-852-2121) twenty-four (24) hours before any street or lane closures.
Contractor or entity must call Renton School District (425-204-4455) or any public/private agency, including public
transit, to be affected by a temporary lane or road closure a minimum of five business days (excluding weekends
and holidays) prior to starting any work.
Contractor or entity must notify King County Metro in writing at construction.coord@kingcounty.gov a minimum
of five business days (excluding weekends and holidays) prior to starting any work impacting bus stops, a
temporary lane or road closure. Work requiring removing a bus shelter or sign requires notification in writing a
minimum of 30 business days (excluding weekends and holidays). Please call King County Metro at 206-477-1140
with any questions.
Any lane or street closures not in conformance with the approved traffic control plan and/or without notification
of emergency services may result in receiving a citation for violation of R.C.W. 47.36.200 Signs or Flaggers at
thoroughfare work sites and R.C.W. 9A.36.050 Reckless Endangerment, and other applicable State and City codes.
Indemnify and hold harmless the City of Renton from any and all claims, actions, and judgments, including all
costs of defense and attorney’s fees incurred in defending against same, arising from and related to
implementation of the approved traffic control plans including claims arising from towing of private vehicles and
the acts of the Permit Holder’s agents and employees.
The City of Renton shall be entitled, in its reasonable discretion, to settle claims prior to suit or judgment, and in
such event shall indemnify and hold harmless the City for any such claims paid, including the City’s reasonable
attorney’s fees and litigation costs incurred resulting from such claim.
In the event any claim or suit is brought against City within the scope of this Agreement, Permit Holder will pay for
legal counsel chosen by the City to defend against same.
Flagger and sign placement are subject to revision by the City Inspector on site, if needed to address traffic or
pedestrian safety or travel.
All permit conditions shall be met.
NOTES:
Total road closure lasting more than twenty-four (24) hours is subject to the approval by the City Council.
Work Zone Traffic Control shall be in accordance with the Manual on Uniform Traffic Control Devices (MUTCD)
and shown by a traffic control plan layout or reference to WSDOT.
Approved Temporary Traffic Control Plan must be at the work site during work hours.
Complete assistance and accommodation shall be provided to all kinds of pedestrian traffic when sidewalk or
walkway is impeded to safely redirect pedestrians around a work zone.
Signage shall be used to warn motorcyclists/bicyclists of the potential hazards on any uneven surfaced or slippery
road conditions during work and non-work hours.
Any vehicle, equipment, barricade, or portable tow-away sign used within the work area must display a company
logo or any legally acceptable sign showing the company name, address, and telephone number at a conspicuous
place on the vehicle or equipment.
Note: The Applicant is responsible for compliance with all codes and regulations, whether or not described in this document.
Page 3 of 3 | Published: 10/27/2021
In the case of Temporary No Parking Zones, all the following apply in addition to previous:
Contractor must complete form to show limits of Temporary No Parking Zone identifying barricade locations for
vacate parking or curb lane usage.
Contractor must post notice of dates and time of Temporary No Parking Zone with at least two signs per block
seventy-two (72) hours in advance of effective date and time.
The cover sheet of this Traffic Control Plan form must be attached to each Temporary No Parking Sign on the
project site.
Temporary traffic control devices must be removed immediately when work is done or no construction activities
are going on. If deemed abandoned, City crews will remove and store them at the City’s maintenance shop (3555
NE 2nd Street).
I certify that the information on this application and within the submittal documents are accurate to the best of my
knowledge and I acknowledge all the requirements on this application.
Applicant’s Signature Date
Applicant’s Name (Print)
Austin Sweeney
Austin Sweeney 1/5/2023
N
TRAFFIC CONTROL PLAN
JOB # P. 066860. C. 45
PERMIT #
N 24TH ST @ GARDEN CT N
REMOVE AERIAL
ONE-LANE TWO-WAY OPERATION
LEGEND
CONES FLAGGER
POLE WORK AREA
WORK TRUCK
Jeffrey Hubbard
Comments:
CHANNELIZATION SPACING
MPH TAPER TANGENT
25 / 30 20' 40'
35 / 45 30' 60'
ONE-LANE TWO-WAY TAPER 50' TO 100'
NOT TO
SCALE Comments:
MERGING TAPER LENGTH
TAPER ("L") LANE WIDTH
L MPH 10' 11' 12'
SHIFTING 20 70 75 80
TAPER 25 105 115 165
1/2 L 30 150 165 180
35 205 225 245
SHOULDER 40 270 295 320
TAPER 45 450 495 540
1/3 L 50 500 550 600
Designed For: LUMEN
Project # P. 066860. C. 45
Jeffrey D. Hubbard
Traffic Control Supervisor
WA TCS # 011989
Draw Date: 1/3/2023
Phone 253-737-5198
jhubbard.tcp@gmail.com
_______________________
Date:1/3/2023 Author:Jeffrey D. Hubbard, Traffic Control Supervisor Project:P. 066860. C. 45
CERT:WA TCS # 011989 LUMEN:Certified Traffic Control Plan LOCATION:RENTON, WA
Comments:
General Requirements
1. All signs and spacing to conform to the MUTCD and City of RENTON Requirements.
2. Channelizing devices are 28" traffic cones with retro reflective material.
3. All signs are 36" x 36" B/O unless otherwise specified.
4. Alert affected local residents and businesses.
5. Crew is required to leave a minimum 11' for lane width.
6. Work hours will be determined by City of RENTON.
UNLAWFUL FOR ANYONE (OTHER THAN CITY OF RENTON) TO ALTER
THIS CERTIFIED PLAN WITHOUT EXPRESS WRITTEN CONSENT FROM:
JEFFREY D. HUBBARD, TCS# 011989, JHUBBARD.TCP@GMAIL.COM
Comments:
REMOVE AERIAL, TRANSFER FACILITIES.
ONE-LANE TWO-WAY OPERATION.
FLAGGERS ASSIST WITH DRIVEWAYS.
FLAGGERS ASSIST WITH PEDESTRIANS.
NOTIFY RESIDENCE PRIOR TO WORK.
Comments:
SIGN SPACING
MPH "X"
20-25 100'
30 200'
35-40 350'
45+ 500'
SPEED
LIMIT25
100' +-100' +-100' +-W20-7ROADWORKAHEADW20-1BEPREPAREDTO STOPW3-4100' +-100' +-100' +-W20-7ROADWORKAHEADW20-1BEPREPAREDTO STOPW3-4DRIVEWAYN 24TH ST
N 24TH ST2020
REMOVE AERIAL
TRANSFER FACILITIES
WORK ZONE
10' X ~150'
GARDEN CT N
www.invarion.com
N
TRAFFIC CONTROL PLAN
JOB # P. 066860. C. 45
PERMIT #
N 24TH ST @ GARDEN CT N
PLACE NEW POLE
ONE-LANE TWO-WAY OPERATION
LEGEND
CONES FLAGGER
WORK AREA WORK TRUCK
Jeffrey Hubbard
Comments:
CHANNELIZATION SPACING
MPH TAPER TANGENT
25 / 30 20' 40'
35 / 45 30' 60'
ONE-LANE TWO-WAY TAPER 50' TO 100'
NOT TO
SCALE Comments:
MERGING TAPER LENGTH
TAPER ("L") LANE WIDTH
L MPH 10' 11' 12'
SHIFTING 20 70 75 80
TAPER 25 105 115 165
1/2 L 30 150 165 180
35 205 225 245
SHOULDER 40 270 295 320
TAPER 45 450 495 540
1/3 L 50 500 550 600
Designed For: LUMEN
Project # P. 066860. C. 45
Jeffrey D. Hubbard
Traffic Control Supervisor
WA TCS # 011989
Draw Date: 1/3/2023
Phone 253-737-5198
jhubbard.tcp@gmail.com
_______________________
Date:1/3/2023 Author:Jeffrey D. Hubbard, Traffic Control Supervisor Project:P. 066860. C. 45
CERT:WA TCS # 011989 LUMEN:Certified Traffic Control Plan LOCATION:RENTON, WA
Comments:
General Requirements
1. All signs and spacing to conform to the MUTCD and City of RENTON Requirements.
2. Channelizing devices are 28" traffic cones with retro reflective material.
3. All signs are 36" x 36" B/O unless otherwise specified.
4. Alert affected local residents and businesses.
5. Crew is required to leave a minimum 11' for lane width.
6. Work hours will be determined by City of RENTON.
UNLAWFUL FOR ANYONE (OTHER THAN CITY OF RENTON) TO ALTER
THIS CERTIFIED PLAN WITHOUT EXPRESS WRITTEN CONSENT FROM:
JEFFREY D. HUBBARD, TCS# 011989, JHUBBARD.TCP@GMAIL.COM
Comments:
PLACE NEW POLE & RESTORE ALL.
ONE-LANE TWO-WAY OPERATION.
FLAGGERS ASSIST WITH DRIVEWAYS.
FLAGGERS ASSIST WITH PEDESTRIANS.
NOTIFY RESIDENCE PRIOR TO WORK.
Comments:
SIGN SPACING
MPH "X"
20-25 100'
30 200'
35-40 350'
45+ 500'
SPEED
LIMIT25
100' +-100' +-100' +-W20-7ROADWORKAHEADW20-1BEPREPAREDTO STOPW3-4100' +-100' +-100' +-W20-7ROADWORKAHEADW20-1BEPREPAREDTO STOPW3-4DRIVEWAYN 24TH ST
N 24TH ST2020
PLACE NEW POLE
RESTORE
WORK ZONE
10' X ~150'
GARDEN CT N
www.invarion.com
N
TRAFFIC CONTROL PLAN
JOB # P. 066860. C. 45
PERMIT #
N 24TH ST @ GARDEN CT N
REMOVE PEDESTAL / PLACE NEW HH / TRENCH
ONE-LANE TWO-WAY OPERATION
LEGEND
CONES FLAGGER
WORK AREA WORK TRUCK
Jeffrey Hubbard
Comments:
CHANNELIZATION SPACING
MPH TAPER TANGENT
25 / 30 20' 40'
35 / 45 30' 60'
ONE-LANE TWO-WAY TAPER 50' TO 100'
NOT TO
SCALE Comments:
MERGING TAPER LENGTH
TAPER ("L") LANE WIDTH
L MPH 10' 11' 12'
SHIFTING 20 70 75 80
TAPER 25 105 115 165
1/2 L 30 150 165 180
35 205 225 245
SHOULDER 40 270 295 320
TAPER 45 450 495 540
1/3 L 50 500 550 600
Designed For: LUMEN
Project # P. 066860. C. 45
Jeffrey D. Hubbard
Traffic Control Supervisor
WA TCS # 011989
Draw Date: 1/3/2023
Phone 253-737-5198
jhubbard.tcp@gmail.com
_______________________
Date:1/3/2023 Author:Jeffrey D. Hubbard, Traffic Control Supervisor Project:P. 066860. C. 45
CERT:WA TCS # 011989 LUMEN:Certified Traffic Control Plan LOCATION:RENTON, WA
Comments:
General Requirements
1. All signs and spacing to conform to the MUTCD and City of RENTON Requirements.
2. Channelizing devices are 28" traffic cones with retro reflective material.
3. All signs are 36" x 36" B/O unless otherwise specified.
4. Alert affected local residents and businesses.
5. Crew is required to leave a minimum 11' for lane width.
6. Work hours will be determined by City of RENTON.
UNLAWFUL FOR ANYONE (OTHER THAN CITY OF RENTON) TO ALTER
THIS CERTIFIED PLAN WITHOUT EXPRESS WRITTEN CONSENT FROM:
JEFFREY D. HUBBARD, TCS# 011989, JHUBBARD.TCP@GMAIL.COM
Comments:
REMOVE PEDESTAL, REPLACE WITH NEW
HH, TRENCH WORK, & RESTORE ALL.
ONE-LANE TWO-WAY TRAFFIC OPERATION.
FLAGGERS ASSIST WITH DRIVEWAYS.
FLAGGERS ASSIST WITH PEDESTRIANS.
NOTIFY RESIDENCE PRIOR TO WORK.
Comments:
SIGN SPACING
MPH "X"
20-25 100'
30 200'
35-40 350'
45+ 500'
SPEED
LIMIT25
100' +-100' +-100' +-W20-7ROADWORKAHEADW20-1BEPREPAREDTO STOPW3-4100' +-100' +-100' +-W20-7ROADWORKAHEADW20-1BEPREPAREDTO STOPW3-4DRIVEWAYN 24TH ST
N 24TH ST2020
REMOVE PEDESTAL
PLACE NEW HH
TRENCH
WORK ZONE
10' X ~150'
GARDEN CT N
www.invarion.com
NOTICE-NOT FOR DISCLOSURE OUTSIDE OF LUMEN AND AFFILIATES EXCEPT UNDER WRITTEN AGREEMENTJOB: BEFORE YOU DIG811CALL TWO WORKING DAYSRNGE:SECT:TOWN:GEO CODE: WC CLLI:TOTAL EXISTING CONDUIT USED:TOTAL NEW BORE:TOTAL NEW DIRT TRENCHESTIMATED TOTALSTOTAL NEW AERIAL:SIDEWALK (PCC) R&R:ASPHALT (AC) R&R:S.F.S.F.L.F.L.F.L.F.L.F.TOTAL NEW ASPHALT TRENCH:L.F.TOTAL NEW S/W TRENCH:L.F.0041350000”NVICINITY MAPSL1415 N 24TH STREETRENTON, WA 98056P.066860W26226RNTNWA0123N5E512/08/2231®CUSTOMER NAME: N/ALCON: N/APHONE #: N/AEMAIL: N/AORDER #: N/AARMOR OR DSR #: N/ASCOPE OF WORK:LUMEN TO PLACE A NEW VAULT & OVERSET THE PEDESTAL, TRENCH TO NEWLY PLACED POLE THEN PLACE A DROP TOTHE HOUSE FROM THE NEW POLE. WRECK OUT THE DROP ON THE OLD POLE. GET THE LINE COUNT ON THE DROP.SH OF DRAFTED BY: MOUNTAIN LTD/MT LTD ENGINEER: RICK FERDINANDOPHONE NO: 206-276-3165EMAIL: rick.ferdinando@lumen.comFIBER ENGINEER: PAULA ELSAEEDPHONE NO: 253-458-6583EMAIL: paula.elsaeed@lumen.com
TTTTTEEEEE CATV CATV CATV CATV CATV CATV CATV CATV GGGGG TS TS TS TS TS WWWWW S S S S S SD SD SD SD SD C/L C/L C/L C/L C/L C/L R/W R/W R/W R/W R/W R/W R/W P/L P/L P/L P/L P/L P/L B/C B/C B/C B/C B/C B/C B/C B/C EOP EOP EOP EOP EOP TTTUSAMEEPWREE CATV
CATV TVTV CATV CATV CATV CATV CATV CATV CATV CATV VTS C/L C/L VWSSDVETTTXXX'XXX'XXX'XXX'X IRRIG IRRIG F1TTTTTTNOTICE-NOT FOR DISCLOSURE OUTSIDE OF LUMEN AND AFFILIATES EXCEPT UNDER WRITTEN AGREEMENTJOB: RNGE:SECT:TOWN:GEO CODE: WC CLLI: BEFORE YOU DIG811CALL TWO WORKING DAYSRNGE:SECT:TOWN:JOB:GEO CODE:WC CLLI:DRAFTED BY: MOUNTAIN LTD/SH OF SL1415 N 24TH STREETRENTON, WA 98056P.066860W26226RNTNWA0123N5E512/08/2232®MT LTD ENGINEER: RICK FERDINANDOPHONE NO: 206-276-3165EMAIL: rick.ferdinando@lumen.comFIBER ENGINEER: PAULA ELSAEEDPHONE NO: 253-458-6583EMAIL: paula.elsaeed@lumen.com
EOP EOP EOP EOP EOP EOP EOP EOP EOP EOP EOP EOP R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W EOP EOP EOP EOP EOP EOP EOP EOP EOP EOP EOP EOP EOP EOP TT x x x //NOTE:LUMEN TO PLACE A NEW 3048 HANDHOLE & OVERSETTHE PEDESTAL, TRENCH 2" DIRT TO NEWLY PLACEDPOLE THEN PLACE 135' DROP TO THE HOUSE FROMTHE NEW POLE. WRECK OUT THE DROP ON THE OLDPOLE. GET THE LINE COUNT ON THE DROP.STATIONPSEPROPOSED HOAPOLE NUMBER(S) - LMN/PWR/OTHERWRECK OUT DROPSN/A319013-166262TO BE REMOVEDA0501280N/AOLDSTATIONPSEPROPOSED HOAPOLE NUMBER(S) - LMN/PWR/OTHERTRANSFER EXISTING DROP TO POLEN/ATO BE PLACEDTRANSFERNEWN/ANEW1415N 24th STREETPARCEL#33445002341405PARCEL#33445002361404PARCEL#0523059004 x
x
x
//N 24th STREET C/L C/L C/L R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W R/W 10'21'T4'
MEADOW AVE N
MEADOW AVE N NOTE:REMOVE EXISTINGUNDERGROUND DROP FROMEXISTING POLE & TRANSFERTO NEW HANDHOLE.1412PARCEL#05230590372407PARCEL#052305906225SPEEDLIMITNOTE:FOR UNDERGROUND ACTIVITY: TEST AND VENTILATEMANHOLE/UTILITY VAULT PRIOR TO ENTRY, PLACEWARNING DEVICES AND WORK AREA PROTECTION ASREQUIRED, AND USE EYE AND HEAD SAFETY PROTECTIONPER FEDERAL, STATE, AND LOCAL REGULATIONS.NOTE:THE RIGHT-OF-WAY SHOWN HAS NOT BEEN SURVEYEDOR TIED. RIGHT-OF-WAY LOCATION IS ASSUMED WITHREFERENCE TO ONLINE DATA SOURCE MATERIALS.CONTRACTOR TO VERIFY ALL RIGHTS OF WAY AND/OREASEMENTS PRIOR TO CONSTRUCTION.NOTICE-NOT FOR DISCLOSURE OUTSIDE OF LUMEN AND AFFILIATES EXCEPT UNDER WRITTEN AGREEMENTRNGE:SECT:TOWN:JOB: GEO CODE: WC CLLI: BEFORE YOU DIG811CALL TWO WORKING DAYSSL1415 N 24TH STREETRENTON, WA 98056P.066860W26226RNTNWA0123N5E512/08/2233RSH OF DRAFTED BY: MOUNTAIN LTD/MT LTD ENGINEER: RICK FERDINANDOPHONE NO: 206-276-3165EMAIL: rick.ferdinando@lumen.comFIBER ENGINEER: PAULA ELSAEEDPHONE NO: 253-458-6583EMAIL: paula.elsaeed@lumen.comPSE pole to move back 6Underground alltelecommunicationsbetween poles
DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
Minor Franchise Permit: MFP23000082
IVR Number: 23000082
Permit Information
Permit Name: P.066860
Address/Location:01/05/2023Application Date:3344500234Parcel Number: 1417 N 24TH ST
Permit Type:01/05/2023Issue Date:Franchise
Permit Work Class:01/05/2024Expiration Date:Minor Utility
Job Number: P.066860Franchise Type:Telephone
Description: APPROVED WITH REDLINE COMMENTS. Lumen to remove aerial drops from pole A0501280, transfer 1 existing
aerial drop to new pole, replace Ped with new HH, and trench approx. 2’ from new HH to new pole. Undergrounding
required between poles on frontage. See site plans for redline comments. Pothole all existing utilities. Restoration
per City of Renton standards
Contacts
Name Address PhoneTypeBilling
Austin Sweeney
Century Link
23315 66th Ave S
Kent, WA 98032
C: (253) 766-7549ApplicantX
Kim Parker
QWest Corporation
931 14th St, Suite 1000A
Denver, CO 80202
B: (303) 992-0752Contact
Austin Sweeney
Century Link
23315 66th Ave S
Kent, WA 98032
C: (253) 766-7549Contact
Jesse Patjens
CenturyLink / Lumen
23315 66th Ave S
Kent, WA 98032
Contact
Michael Smith
North Sky Communications
21320 84th Ave S
Kent, WA 98032
C: (206) 305-5881Contractor
Business License Number: 36846Construction Contractor: NORTHSC857Q4
CITY OF RENTON ROW 1055 S Grady Way
Renton, WA 98057-3232
Owner
QWest/Century Link - Billing 23315 66th Ave S
Kent, WA 98032
Specialized
Billing
General Conditions & Signature
Permission is hereby given for the work described on this permit according to the conditions hereon and according to the
approved plans and specifications pertaining thereto, subject to compliance with the Ordinance of the City of Renton.
Ÿ
This permit and plans must be posted at the job site at all times.Ÿ
I hereby certify that no work is to be done except as described above and in approved plans, and that work is to conform to
Renton Trench Restoration and Street Overlay Requirements.
Ÿ
Call 425.430.7203 or go to: https://permitting.rentonwa.gov one working day in advance to schedule an inspections and for ANY
work in the Right of Way.
Ÿ
Call 8 1 1 to locate underground utilities at least two full business days prior to any excavation.Ÿ
In accordance with RCW 19.122.033(4) the permit holder is required to contact (Williams Northwest Pipeline at 425.868.1010)
(Olympic Pipeline at 425.235.7736) (Puget Sound Energy at 425.375.3397) to request a consultation with the transmission
pipeline company prior to performing any construction or excavation activities. This requirement to consult with the
transmission pipeline company is in addition to the requirement to Call before You Dig as required in RCW 19.122.
Ÿ
(Date)(Signature)
Page 1 of 1THIS PERMIT AND PLANS MUST BE POSTED AT THE JOB SITE AT ALL TIMES