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SIDE SE\TER
PERMIT APPLICATIOI{RECEtwffitr:
JUL 12 züif
DEVËLOPMETT I SEI{VI(;Ir
COUNTËñ
CONTRACTOR INFORMATION:
Company Name
Company Address:
Site Contact:
#:
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City:
State License #
Expiration Date:
PROPERTY INFORMATTQITi
Address:a
Ownerts Name:
Zipz Email #:ì<
City Business License #
Phone #:
úu"rLrNE RErLAcEMENT I spor RErATR I prpn BURST I nELNn GERMALINE ONLY)
' DESCRIPTION OF PROPOSED WORI( (Be Specific):
)/
ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE PERMISSION TO V/ORK ON ANY PROPERTY OTHER
THAN THAT OWNED BY THE SUBJECT PROPERTY O\ryNER.
CERTIFICATIONS NECESSARY FORINSTALLATION 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 OWNERS EXPRESS PERMISSION TO PER-FORM V/ORK ON THAT ADJACENT
PROPERTY.
SIGNATURE DATE
or Agent
NO WORK SHALL BEGIN PRIORTO PERMIT ISSUANCE
CITY OF EDMONIDS
¿c. l8
STATUS: ISST]ED
I2I 5TH AVENUENORTH - EDMONDS, WA 98020
PHONE: (425)771-0220 - FAX: (425)771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
8NG20190345
SIDB SBWER PERMIT (r-S Family)
Permit Number: ENG20 1 90345
Job Address:730 CARY RD, EDMONDS
Expiration Date: 07 /22 12020
APPLIC-,{NT C]ONTRACTOR
THE LEREN COMPANY
PO BOX 12863
MILL CREEK, WA 98082
STROMME CONSTRUCTION LLC
9623 9TH AVE NE
SEATTLE, WA 98I I5
(206) 6s0-7378
LICENSE #: STROMHISTTCM EXP 03/29/2020
PROPOSETORzuSELATERAL
PROPOSETO REUSE SIDE SEWER
LIDNUMBER:
DRAINACE
PROJECT CROSSES OTHER PRIVATE PROPERTY
VERIFICATION OF RECORDED EA SEMENTS COMPLETE
INDEMMTY The Applicant has signed an application which stales he/she holds the City of Edmonds harmlessfrom injuries,
dantages or claims of any kind or descripÍion whatsoever,þreseen or unforeseen, Íhal may be made against the City of Edmonds or
any ofits departments or employees, including but nol limited to the defense ofany legal proceedings including defense costs and
aîtorneyfees by reason ofgranting this permil.
CALL DIALA-DIG (t -800 -424-5555) BU'Onr AXy Ð(CAVATTON
CALL FOR INSPECTION (425) 7 7 l-0220 Ð(T. I 326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
RELEASED BY DATE
Y Y
N
REPAIR
CR.INDERPLII\4P N N
INSTALLNEW SEWERLINE
N
N
.IOB DLSCRIPTION
EAS F,ivIÐ\T IN FO RMATIO N
THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
TI]IS APPLICATION IS NOT A PERMITUNTIL SIGNED
Printed: Tues J 20t9
,{PPLIC,{TION APPROVAL
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