0317_001.pdfO \. t'V'Uy
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
rg'), PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20180570
SIDE SEWER PERMIT (I -Single Fa"Iy)
Permit Number: ENG20180570 Expiration Date: 02/22/2020
Job Address: 7902 203RD ST SW, EDMONDS
CONTRACTOR
SELECT HOMES INC. SELECT HOMES INC.
16531 13TH AVE W SUITE A107 16531 13TH AVE W SUITE A107
LYNNWOOD, WA 98036- LYNNWOOD, WA 98036-
(206) 963-3787
LICENSE 4: SELECHII IOKN EXP: 12/31/2018
ilREPAIR
DESCRIPTIONJOB
N PROPOSE TO REUSE LATERAL LID NUMBER:
GRINDER PUMP N PROPOSE TO REUSE SIDE SEWER N DRAINAGE
Install sewer line.
EAS EMENT INFORMATION
N
PROJECT CROSSES OTHER PRIVATE PROPERTY
N
VERIFICATION OF RECORDED EASEMENTS COMPLETE
INDEMNITY The Applicant has signed an application which states he/she holds the City of Edmonds harmless from injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorney fees by reason ofgranting this permit.
CALL DIAL -A -DIG (1-800424-5555) BEFOREANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
APPLICATION APPROVAL
THIS APPLICATION IS NOT A PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Friday, February 22, 2019
Z�)"e� /t% erL 2/22/19
RELEASED BY DATE
FILE COPY INSPECTOR COPY APPLICANT COPY
STATUS: ISSUED
• None
• None
PARTIAL INSPECTION
PARTIAL INSPECTION
FINAL INSPECTION APPROVED
DATE: INITIAL: NOTES:
DATE: INITIAL: NOTES:
DATE: INITIAL:
ENG20180570
of ED%� ,V.
-INC. 1 SOO
CONTRACTOR INFORMATION:
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ojc�20&-0570
SIDE SEWER
PERMIT APPLICATION
Company Name: &a, Ie Vyi !2:->, l I v, C Site Contact:
Company Address: �S.j 1 iV- Ave L,3 Phone #:
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City: I �4 V vivljp j , Zip: df $ 03� Email #:
State License # S, E11l✓C H111. nr.Q City Business License # Q.R.. O z S�
Expiration Date:
PROPERTY INFORMATION:
Address: -7f '70
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Owner's Name:
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Phone #: q Z� . 0
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❑ FULL LINE REPLACEMENT ❑ SPOT REPAIR ❑ PIPE BURST ❑ RELINE (PERMALINE ONLY)
DESCRIPTION OF PROPOSED WORK (Be Specific):
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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 PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY. / a�
SIGNATURE G DATE
ontractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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