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CITY OF EDMONDS
1215THAVENUENORTH- EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSTTE*
STATUS: ISSUED ENG20190130
SIDE SEWER PERMIT (]-Single Family)
Permit Number: ENG20190130 Expiration Date: 06/20/2020
Job Address: 715 SPRUCE ST, EDMONDS
APPLICANT O.
SELECT HOMES INC. SELECT HOMES INC.
16531 13TH AVE W SUITE A107 16531 13TH AVE W SUITE A107
LYNNWOOD, WA 98036- LYNNWOOD, WA 98036-
(425)742-6044
LICENSE #: SELECHII 1 OKN EXP: 12/31 /2019
N
N
i DESCRIPTION
PROPOSE TO REUSE LATERAL LID NUMBER:
REPAIR HN
GRINDER PUMP PROPOSE TO REUSE SIDE SEWER N DRAINAGE
INSTALL SIDE SEWER FROM PL CLEAN OUT TO HOUSE
LAS LMENT INFORMATION
N
PROJECT CROSSES OTHER PRIVATE PROPERTY
N
VERIFICATION OF RECORDED EASEMENTS COMPLETE
INDEMNITY The Applicant has signed an application which states 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 ofits 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 DIALrA-DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
APPLICATIONAPPROVAL
THIS APPLICATION IS NOT A PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED
Printed: Wednesday, June 19, 2019
Z�)d4e-�z x'44�Z' 6/20/19
RELEA SED BY
DATE
❑ FILE COPY ❑ INSPECTOR COPY ❑ APPLICANT COPY
STATUS: ISSUED
ENG2O19O13O
• 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/Contractorto provide Side Sewer asbuilt at final inspection. See City Standards for requirements.
INSPECTIONS
• IsSanitary Side Sewer Inspection
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
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SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name:
Company Address: J �os;�il l3 CN -
City: uo00j Zip` 63
State License# SELI%i EiZ��.��
Expiration Date: rZ • -,� l • l
PROPERTY INFORMATION:
Site Contact:
Phone #:
Email #: o
VtdwLc.s r.�la • Ce�wr
City Busi e s LiA� e # �� • Z�S�?
Address: 74 l<; Sp V u c� St:
Owner's Name:
Se.le.c� k�owJ�S . l ►��.
Phone#: �Zs.-.`!J-Z,(6LlCI
❑ FULL LINE REPLACEMENT ❑ SPOT REPAIR ❑ PIPE BURST ❑ 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 G DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE