0319_001.pdf1p CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
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*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20190038
SIDE SEWER PERMIT (I -Single Family)
Permit Number: ENG2019003 8 Expiration Date: 02/22/2020
Job Address: 7904 203RD ST SW, EDMONDS
APPLICANT 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: SELECHI I 1 OKN EXP: 12/18/2019
N
N
JOB DESCRIPTION
PROPOSE TO REUSE LATERAL LID NUMBER:
REPAIR HN
GRINDER PUMP PROPOSE TO REUSE SIDE SEWER FN DRAINAGE
Installation
of side sewer
EASEMENT IN FORMATION
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) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
APPLICATION APPROVAL I
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Friday, February 22, 2019
/t/le&apt' 2/22/19
RELEA SED BY
DATE
❑ FILE COPY ❑ INSPECTOR COPY ❑ APPLICANT COPY
STATUS: ISSUED
ENG20190038
• Refer to City of Edmonds Side Sewer Infonnation handout for approved pipe materials, inspections and other requirements.
• A 6" cleanout with 12" locking cast iron lamphole cover is required at the property line.
• Maintain 10' separation between the sanitary side sewer and the water service line.
• A separate right-of-way construction permit is required for work within the City right-of-way.
• Condition of the a)dsting lateral to be verified by the City's Public Works Dept. to obtain approval for reuse. Contact Edmonds
Sewer Division at 425-771-0235.
• Condition of the existing sanitary side sewer to be verified prior to obtaining approval for reuse. TV inspection required. Video
to be submitted to City for review.
• Easement and/or permission from adjacent property owner is required prior to entry/work within adjacent property.
• Applicant -shall repair/replace all damage -to utilities -or frontage improvements in -City right-of-way per City standards that is
caused by or occurs during the pemutted project.
• Owner/Contractor to -provide -Side Sewer asbuilt at final inspection. See City -Standards for requirements.
• Sound/Noise originating from temporary construction sites as aresult of construction activity are exempt fromthe noise limits
of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on weekdays and 10:00am and 6:00pm 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.
• Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
hannless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance not limit in any way the City's ability to enforce any ordinance
provision.
• E-Sanitary Side Sewer Inspection
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
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CONTRACTOR INFORMATION:
ej 42a19-0038
SIDE SEWER
PERMIT APPLICATION
Company Name: S;dCGk 14 0V , gs 1"7 C _ Site Contact:
Company Address: I uS2 i i,- 1, Avy l.J Phone #:
S-k. �410-1
City: IVIyihvoo0a Zip: c1gV3-- Email#: F-CnL, Gt•Co41+-�U�-C�vi.�
State License # 1 `6 � E-CH =-1 O � I� City Business LiUnse # �� 6 7,6, 5 �Z
Expiration Date: J �7
PROPERTY INFORMATION:
Address: -� %� l Jn4-' S' l
Owner's Name: W
S e Ie4 P 'n v+l e.S . I L".,:f—
Phone #: 2-S - 74 Z & y�
❑ 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.
SIGNATUREC DATE L �� r
tractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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