20170511142258.pdfof Ebttf
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
I PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20170186
SIDE SEWER PERMIT (I -Single Family)
Pertnit Number: ENG20170186 Expiration Date: 06/11/2017
Job Address: 8023 208TH PL SW, EDMONDS
APPLICANT CONTRACTOR
Sewer Friendly Sewer Friendly
P.O. Box 3415 P.O Box 3415
Lynwood, WA 98046
Lynwood, WA 98046
(42S) 478-3 133
LICENSE 4: SEWERFL916MS EXP: 07/10/2017
MENER&W Elm=
REPAIR N PROPOSE TO REUSE LATERAL LIDNUMBER:
GRINDERPUMP N I PROPOSE TO REUSE SIDE SEWER F-N1 DRAINAGE
7trench backside of house from 4" cast iron pipe to e)dsting 6" concrete pipe. Install new 4" PVC sewer line from house to shared
61" line and make all necessary connections including 4" & 6" cleanouts to grade.
FAS EMENT INFORMATION
PROJECT CROSSES OTHER PRIVA TE PROPERTY
N IVERIFICATION OF RECORDED EASEMENTS COMPLETE
IADEMATTY- The Applicant has signed an application which states helshe holds the City ofEdmonds harmlessfrom injuries,
damages or claims ofany kind or description whalsoever, foreseen or unforeseen, that may be made against the Cily ofEdmonds or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorneyfees by reason ofgranting this permit.
CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECUON REQUESTS
THIS APPLICA71ON IS NOTA PERMTUNTTL SIGNED BY THE CITY ENGINEER OR HISMER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED.
10
DA
Printed:Thursday. Mav 11. 201
E] FILE COPY F-] INSPECTORCOPY F-1 APPLICANT COPY
STATUS: ISSUED
ENG20170186
• Refer to City of Edmonds Side Sewer Information handout for approved pipe materials, inspections and other requirements.
• A 6" cleanout with 12" locking cast iron lamphole cover is required at the property line.
• Maintain I O'separation between the sanitary side sewer and the water service line.
• A separate right-of-way construction permit is required for work within the City right-of-way.
• Condition of the eidsting 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 e)dsting sanitary side sewerto be verified priorto obtaining approval for reuse. TVinspection required. Video
to be submitted to City for review.
• Easement and/or permission fi-om adjacent property owner is required prior to entry/work within adjacent property.
• Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way per City standards that is
caused by or occurs during the permitted project.
• Owner/Contractor to provide Side Sewer asbuilt at final inspection. See City Standards for requirements.
• Sound/Noise originating from temporary construction s ites as a result of construction activity are exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 6:00pm on weekdays and 10:00am and 6:00pm on Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originating from construction sites /activities must comply with tile
noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
• Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance not limit in any way the City's ability to enforce any ordinance
provision.
• &As -built
• E-Sewer Water test
• E-Sanitary Side Sewer Inspection
PARTIAL INSPECTION DATE: INITIAL:
PARTIAL INSPECTION DATE: INITIAL:
FINAL INSPECTION APPROVED DATE: INITIA L:
NOTES:
NOTES:
of EV1.10 44
SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name:
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Site Contact: ko�, V Phone
Mailing Address: p,0. BG.4, -34 Lo*�. Fax
State License #: 5*,Z�'Vb R P L
Expiration Date:
City Business License #:
PROPERTY INFORMATION:
Email #: in foaieww4k,tvA 1k. 000\
—0 Liability Insurance L1 B4nded
Address: WA qma
Owner's Name Aip
Phone#:
O'Full Line Replacement Spot Repair [:1 Pipe Burst El Reline (PermaLine Only)
DESCRIPTION OF PROPOSED WORK (Be Specific):
L4106N PV C I Ke, �6N �OOUte- ii-, fl(tft� � ILA �14 pe, 6[v)� 01 (A 6, Q
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SIGNATURE
/ - Cont #to r or/Agent
DATE Q�Jl t lawl
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE