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Side Sewer Application.pdfCONTRACTOR INFORMATION: Company Name: SIDE SEWER PERMIT APPLICATION Ll PnC �L'n Site Contact: Company Address:10 r Phone #: % E7E Zip: �'"'Email #:Ire, ,- # �LU ClCity Business License # ate: ( l/�� PROPERTY INFORMATION: r i �`' ,� l,� �y Address: l �°7 i� 2 1-71- 1 p 1 5 �--d mcnWS WA- � g- Owner's Name: d Les4 fr dn v�cl (VI CV'Qfl J"`L Il �� Phone #: ❑ FULL LINE REPLACEMENT ❑ SPOT REPAIR *PIPE BURST ❑ RELINE (PERMALINE ONLY) DESCRIPTION OF PROPOSED WORK (Be Specific): Sewer l� ,1' *-7 n a .�NA fret- �i!" rlc�ts� ca-JPP� ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE PERMISSION TO WORK ON ANY PROPERTY OTHER THAN THAT OWNED BY THE SUBJECT PROPERTY OWNER. CERTIFICATIONS NECESSARY FOR INSTALLATION METHODS ARE THE RESPONSIBILITY OF THE CONTRACTOR PERFORMING SAID WORK. I REPRESENT AND WARRANT TO THE CITY OF EDMONDS, IF REPAIR OF EXISTING SEWER EXTENDS TO AN ADJACENT PROPERTY, I HAVE OWNERS EXPRESS PERMIISSION TO PERFORM WORK ON THAT ADJACENT PROPERTY. SIGNATURE DATE Contractor or Agent NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE