1485_001.pdfA Ol. LDMU
vCP CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20190127
SIDE SEWER PERMIT (]-Single
Permit Number: ENG20190127 Expiration Date: 06/20/2020
Job Address: 713 SPRUCE ST. EDMONDS
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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 #: SELECHII 1 OKN EXP: 12/31 /2019
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JOB DESCRIPTION
REPAIR L_L4j PROPOSE TO REUSE LATERAL LID NUMBER:
GRINDER PUMP N PROPOSE TO REUSE SIDE SEWER FN 1 DRAINAGE
INSTALLATION OF NEW SIDE SEWER AND CLEAN OUT AT P/L
EASEMENTO'
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PROJECT CROSSES OTHERPRIVATEPROPERTY
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VERIFICATION OF RECORDED EASEMENTS COMPLETE
INDEMNITY The Applicant has signed an application which stales he/she holds the City ofEdmonds harmless from injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City ofEdmonds or
any of ils 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 DIALGA-DIG (1-800-424-5555) BEFOREANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT.1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
APPLICATION APPROVAL
THIS APPLICATION IS NOTA PER"TUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PRON71DED.
Printed: Wednesday, June 19, 2019
Z�)gou�z 6/20/19
RELEA SED BY DATE
C�xFILECOPY ❑ INSPECTOR COPY ❑ APPLICANT COPY
STATUS: ISSUED
ENG20190127
• Call for locates of underground utilities prior to any excavation.
• Utility patch restoration to be in accordance with Edmonds Standard detail E2.3
• Refer to City of Edmonds Side Sewer Information handout for approved pipe materials, inspections and other requirements.
• Condition of the existing 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.
• 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:
�N 4 & 11 () 12-7
SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name:
Company Address:
City: l�,,ti vuDU� Zip` � b
State License # SELEHZ114.(—
Expiration Date: r2 • I I
PROPERTY INFORMATION:
Site Contact:
Phone #:
Email #:
Vt 0 rr. G S I�tJGi • C_ d' w�
City Busi . s Lic�Ae #
Address: � I'2
Owner's Name:
Se le.ck vic.
Phone#: �Z� s,-lZ,(,DqJ
[] FULL L ❑ SPOT REPAIR ❑ PIPE BURST ❑ RELINE (PERMALINE ONLY)
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DESCRIPTION OF PROPOSED WORK (Be Specific):
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 METI-IODS ARE TFIE 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 G DATE • Z� ��
/ Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE