1370_001.pdfCITY OF EDMO}{DS
I21 5TH AVENUENORTH - EDMONDS, V/A 98020
PHONE: (425)771-0220 - FAX:(425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSI]ED 8NG20190221
srDE sEwER PERMIT (r
Permit Number: ENG20 I 90221
Job Address: 115 EDMONDS S EDMONDS
Exp iration Date : 06 / 09 12020
APPLIC,{NT C]ONTRACTOR
CRITCHLOW HOMES
PO BOX 13400
CRITCHLOW HOMES
PO BOX 13400
MILL CREEK. WA 98082-MILL CREEK, WA 98082-
(425) 743-444'l
LICENSE #: CRITCHI055JP EXP: 02101/2019
PROPOSETORzuSELATERAL
PROPOSE TO RzuSE SIDE SEWER
LIDNUMBER:
DRAINACÐ
PROJECT CROSSES OTHER PRIVA TE PROPERTY
TION OF RECORDED EASEI\4ENTS COMPLETE
INDEMMTY The Applicant has signed an applicalion which states he/she holds the City of Edmonds harmlessfrom injuries,
damages or claims of any kind or descripÍion ,whatsoe,¡,er, foreseen or unþreseen, f hal may be made againsÍ the Cily of Edmonds or
any ofits depørtments or employees, including but noÍ limited to the defense ofany legal proceedings including defense costs and
atlorneyfees by reason ofgranting fhis permit.
CALL DIALA-DIG (1 -800 -424-5555) BB'ORE Ar\rY D(CAVATION
CALL FOR INSPFCTION (425) 7 7 t -0220 D(T. I 326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUBTS
NIR
N CRINDERPUMP
N
N N
INSTALL SIDE SEWER FROM CLEAN OUT AT PROPERTYLINE TO HOUSE
N
N
.I()B DLS(]RIPTION
EAS EMB{T INFO RMATION
TIIIS APPLICATION IS NOTA PERM]TUNTIL SIGNED BY THE CIry ENGINEEROR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTiS ACKNOVr'LEDGED IN
SPACE PRO\4DETJ
June IPrinted
,\PPLIC.{TION APPROVAL
A FII,ECOPY INSPECTORCOPY ! amucANTCoPY
STATUS: ISSUED ENG20190221
. Call for locates of underground utilities priorto any e>rcavation.. Utility patch restoration to be in accordance with &lnrcnds Standard detatlB2.3¡ Maintain erosion & sedimentation control. Keep street clean.¡ Refer to City of Rlmonds Side Sewer Infornration handout for approved pipe nraterials, inspections and other requirements.. Condition of the existing lateral to be verified by the City's Public \ù/ork Dept. to obtain approval for reuse. Contact Edmonds
Sewer Division at 425-771-0235.
. C-ondition of the eisting s anitary s ide sewer to be verified prior to obtaining approval for reuse. TV inspection required. Video
to be submitted to Cþ for review.
. Applicant shall repair/replace all danrage to utilities or fi'ontage improvements in Cify right-oÊway per City standards that is
caused by or occurs during the permitted project.
¡ Owner/Contractorto provide Side Sewer asbuilt at final inspection. See City Standards for requirements.
a E-Sanitary Side Sewer Inspection
PARTIALINSPECTION DATE:
PARTIALINSPECTION DATE:
FINALINSPECTIONAPPROVED DATE:
INITIAL:
INITIAL:
INITIAL:
NOTES:_
NOTES:_
SIDE SEWER PEIÌMIT (l-Single Family)
CONDTTIONS
INSPECTIONS
CONTRACTOR INF'ORMATION:
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SIDE SE\ryER
PERMIT APPLICATION
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ExpirationDate: 2 . 1 b - Zl
PROPERTY INFORMATION:
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Owner's Name:
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DESCRIPTION OF PROPOSED WORK (Be Specifïc):
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ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE PERMISSION TO V/ORK 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 V/ARRANT TO THE CITY OF EDMONDS, IF REPAIR OF EXISTING SEV/ER EXTENDS TO AN
ADJACENT PROPERTY,I HAVE O\ryNERS EXPRESS PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY
DATE 5. ZO
Contractor or Agent
SIGNATURE
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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