1370_001.pdfof EL)M
CITY OF EDMONDS
121 5THAVENUENORTH-EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20190221
SIDE SEWER PERMIT
Permit Number: ENG20190221 Expiration Date: 06/09/2020
Job Address: 115 EDMONDS ST, EDMONDS
APPLICANT O.
CRITCHLOW HOMES CRITCHLOW HOMES
PO BOX 13400 PO BOX 13400
MILL CREEK, WA 98082-
MILL CREEK, WA 98082-
(425)743-4447
LICENSE 4: CRITCH1055JP EXP: 02/01/2019
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JOB DESCRIPTION
REPA IR N PROPOSE TO REUSE LATERAL LID NUMBER:
I GRINDER PUMP N PROPOSE TO REUSE SIDE SEWER N DRAINAGE
INSTALL SIDE SEWER FROM CLEAN OUT AT PROPERTY LINE TO HOUSE
LASEMENTINFORMATION
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PROJECT CROSSES OTHER PRIVATE PROPERTY
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IVERIFICATION OF RECORDED EASEMENTS COMPLETE
1N7)EMMTY 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 ofgranling this permit
CALL DIAL -A -DIG (1-800-424-5555) BET'OREANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
THIS APPLICATION IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Monday. June 10, 201
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FILECOPY INSPECTORCOPY ❑ APPLICANT COPY
STATUS: ISSUED
ENG20190221
• Call for locates of underground utilities prior to any excavation.
• Utility patch restoration to be in accordance with Edmonds Standard detail E2.3
• Maintain erosion & sedimentation control. Keep street clean.
• Refer to City of Edmonds Side Sewer Information handout for approved pipe materials, inspections and other requirements.
• Condition of the e)asting 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.
• Applicant shall repai►•/replace all damage to utilities or fi•ontage improvements in City right-of-way per City standards that is
caused by or occurs during the permitted project.
• Owner/Contractor to provide Side Sewer asbuilt at final inspection. See City Standards for requirements.
• 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:
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SIDE SEWER
PERMIT APPLICATION
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MAY 2 0 2019
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Company Name: .T 1(0M,4�5 Site Contact: J C— FF � TCW ,�)
Company Address: n a Phone #:
City: Zip: Email #� O�P e— C1k (TCH L,-)V )b1 Oe4rzf, Lt
State License # C IZl T-C_4 I U _To City Business License # /\//Z, ®fib a'7 S
Expiration Date: )- , 15 - 2 1
PROPERTY INFORMATION:
Address:
Owner's Name:
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Phone #:
❑ FULL LINE REPLACEMENT ❑ SPOT REPAIR ❑ PIPE BURST Y ❑ 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.
SIGNATURE DATE 5 �7v —l7
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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