1485_001.pdfCITY OF EDMONDS
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12I5TH AVENTIENORTH - EDMONDS, V/A 98020
PHONE: (425)771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUE,D ENG2019 0127
SIDE SEWER PERMIT (l-Single Family)
Permit Number: bNG20l 90 I 27
Job Address:713 SPRUCE S EDMONDS
Exp iration Date: 06 120 12020
APPLIC,{NT CONTRACTOR
SELECT HOMES INC.
I653I 13TH AVE W SUITE AIOT
SELECT HOMES INC.
I653I I3TH AVE W SI]ITE A I07
LYNNWOOD, WA 98036-LYNNWOOD, WA 98036-
(206) 963-3787
LICENSE #: SELECHIl IOKN EXP. 12/3t/2019
PROPOSETORzuSELATERAL
PROPOSE TO RzuSE SIDE SEV/ER
LIDNUMBER:
DRAINACE
PROJECT CROSSES OTHER PRIVA TE PROPERTY
VERIFICATION OF RECORDED EASEMENTS COMPLETE
INDEMNITY: The Applicant has signed an application which states he/she holds the City of Edmonds harmlessfrom injuries,
damages or claims of any kind or description whatsoever, foreseen or unþreseen, thaf may be made against the City of Edntonds or
any ofits departments or employees, including but nol limited to the defense ofany legal proceedings including defense cosfs and
aÍlorneyfees by reason ofgranÍing lhis permit.
CALL DrALA-DIG (1 -800-424-5555) BU'OREAlW D(CAVATTON
CALL FOR INSPECTION (425\ 7 7 l-0220 Ð(T. 1 326
24 HOUR NOTICEREQUIRTD FOR ALL INSPECTION REQUESTS
Dut/z.¿. l)nho*6t20t19
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REPAIR
RINDERPUMP N N
ALLATION OF NEW SIDE SEWERAND CLEAN OUT AT P/L
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.IOB DESCRIPTION
EAS EMÐ.'IT INFO RMATION
THIS APPLICATTON ISNOTA PERMITUNTIL SIGNED BY THE CIry ENGINEERORHIS/HERDEPUTY: AND FEES ARE PAID,AND RECEIPTIS ACKNOWLEDGED IN
June I 201
SPACE PROVIDED.
Printed: W
,{PPLIC,{TION APPROVAL
RELEASEDBY DATE
(FILECOPY f, nvsrrcroRcoPY [ ,mrucANTCoPY
STATUS: ISSUED ENG2019 0127
. Call for locates of underground utilities prior to any excavation.. Utility patch restoration to be in accordance with Ednronds Standard defailE2.3¡ Referto City of Edmonds Side Sewer lnformation 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 Rlmonds
Sewer Division at 425-771-0235.. Condition ofthe eisting sanitary side sewerto be verified priorto obtaining approval forreuse. TVinspection required. Vdeo
to be submitted to City for review.
¡ Owner/Contractor to provide Side Sewer asbuilt at final inspection. See Cify Standards for requirements.
E-Sanitaly Side Sewer Inspectiona
PARTIALINSPECTION
PARTIALINSPECTION
FINALINSPECTIONAPPROVED DA
DATE:-
DATE:
INITIAL:
INITTAI,:
INITIAL:
NOTES.-
NOTES:
SIDE SEWER PERMIT (l-Single Family)
(]ONDITIONS
INSPECTIONS
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CONTRACTOR INFORMATION:
Company Name:
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City:zip:
State
SIDE SEWER
PERMIT APPLICATIOI{
Site Contact:
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Expiration Date: LZ.Zl. têt
PR.OPERTY INFORMATION:
Address:
Owner's Name:
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DESCRIPTIOI\ 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 METHODS ARE THE RESPONSIBILITY OF THE
CONTRACTOR PERFORMING SAID WORK.
I REPRESENT AND V/ARRANT 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
'IGNAT'RE
2- r¿L,aL-.--lo DATE ?.21 ,lz
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE