1487_001.pdfCITY OF EDMOI{DS
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I2I 5TH A\ENUENORTH - EDMONDS, V/A 98020
PHONE: (425)771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED 8NG20190130
SIDE SEWER PERMIT (l-Single Family)
PermÌt Number: bNG20 I 901 30
Job Address: 715 SPRUCE S EDMONDS
Exp iration Date : 0 6 I 20 I 2020
APPLICANT CONTRACTOR
SELECT HOMES INC.
I653I 13TH AVE W SUITE A107
LYNNWOOD, WA 98036-
SELECT HOMES INC.
I6531 I3TH AVE W SUITE AIOT
LYNNWOOD, WA 98036-
(42s) 742-6044
l-ICENSE #: SEI.ECHII l0KN EXP l2/3112019
PROPOSE TO RzuSE LATERAL
PROPOSE TO RzuSE SIDE SEWER
LIDNUMBER:
DRAINAGE
PROJECT CROSSES OTHER PRIVA TE PROPERTY
TION OF RECORDED EASEMENTS COMPLETE
INDEMMTY The Applicant has signed an applicalion which states he/she holds the City of Edmonds harmless from injuries,
damages or claims ofany kind or description whatsoeyer,foreseen or unforeseen, fhal may be made againsl the City ofEdmonds or
any ofits departments or entployees, including but not limíted to the defense ofany legal proceedings including defense cosls and
attorneyfees by reason ofgranting lhis permit.
CALL DIALA-DIG (1 -800 -424-5 555) BB'ORE Alr[Y D(CAVATION
CALL FOR TNSPECTTON (425) 7 7 t-0220 D(T. I 326
24 HOUR NOTICEREQUIREÐ FOR ALL INSPECTION REQUESTS
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REPAIR
RINDERPUMP N N
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LL SIDE SEV/ER FROM PL CI-EAN OUT TO HOUSE
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.IOB DF^sCRIPTION
EAS EMD{T INFO RMATION
THIS APPLICATON IS NOTA PERMITUNTIL SIGNED BY THE CIry ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PRO\4DED.
Printed: Wednesday, June 19,2019
APPLICATION APPROVAL
RELEASEDBY DATE
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STATUS: ISSUED 8NG20190130
r Refer to Cify of Edmonds Side Sewer Information handout for approved pipe rnaterials, inspections and other requirements.. Condition of the existing lateral to be verified by the City's Public V/ork Dept. to obtain approval for reuse. Contact Edmonds
Sewer Division at 425-771-0235.. Condition ofthe existing sanitary side sewerto be verifìed priorto obtaining approval forreuse. TVinspection required. Video
to be submitted to City for review.
¡ Ovr¡ner/Contractorto provide Side Sewer asbuilt at final inspection. See City Standards for requirements.
BSanitary Side Sewer Inspectiona
PARTIALINSPECTION DATE:- INITIAL:NOTES:
PARTIALINSPECTION DATE:INITIA
FINALINSPECTIONAPPROVED DATE:INITIAL:
NOTES:
SIDE SEWER PERMIT (l-Single Family)
CONDITIONS
INSPECTIONS
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CONTRACTOR INFORMATION:
Company hlame:
Company Address: I
City:
State o s6Lef{axa.oKñ
SIDE SE\MER
PERMIT APPLICATIOI{
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zip:
Site Contact:
Phone #:
Email#: fi,arn rÀsgl1.r*IrtdrrcÇ t.t(^, ( ãw,
City Busiile/s Licb¡ùi# ¡ù?_ .ö?-US-t t
Expiration Date: LZ. ZI . lêl
PROPERTY INFOR.MATION:
Address:
v/u
Ownerts Name:
Phone #:lzs'T4z'Go"lcl
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DESCRIPTION OF PR.OPOSED 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
srcNAruRE 2- t¿L,dÇ-rÇ DATE ?.21 .lq
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE