20170609115405.pdfOv r")-4f
CITY OF EDMONDS
1215THAVENUENORTH- EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSTTE*
STATUS: ISSUED ENG20170227
SIDE SEWER PERMIT (2-M ult-i-Family)
Permit Number: ENG20170227 Expiration Date: 09/08/2017
Job Address: 21010 80TH PL W. EDMONDS
APPLICAN] ('ONTRACTO11
ROTO ROOTER ROTO ROOTER
4630 16TH STREET E, SUITE B9 4630 16TH STREET E, SUITE B9
FIFE, WA 98424
FIFE, WA 98424
(425) 346-0027
LICENSE #: ROTORSC122BR EXP: 04/03/2018
YdREPAIR
N
IOB DESCRIPTION
N PROPOSE TO REUSE LATERAL LIDNUMBER:
GRINDER PUMP N PROPOSE TO REUSE SIDE SEWER FN`� DRAINAGE
INSTA LL CLEANOUT AND REPAIR CORNER BY HOUSE
LAS LINIENTINFO RMATION
N
PROIECT CROSSES OTHIR PRIVATE PROPERTY
N
d VERII- [CATION OF RECORDED EASEMENTS COMPLEFE
IADEMATTY- The Applicant has signed an application which states helshe holds the City ofEdmonds harmlessfrom injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City ofEdmonds or
any ofils departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
atiorneyfees by reason ofgranting thispermil.
CALLDIAL,A-DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
ITHIS APPLICATION IS NOT A PERNIITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HERDEPUTY- AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROTODED. Printed: Friday. Ju
SED BY
El FILE COPY F—] INSPECTOR COPY
DATE
F-� APPLICANT COPY
STATUS: ISSUED
ENG20170227
• 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 10'separation between the sanitary s ide 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 e)dsting 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 sewer to be verified prior to obtain ing approval for reuse. TV inspection 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 pen -flitted project.
• Owner/Contractorto provide Side Sewer asbuilt at final inspection. See City Standards for requirerrients.
• Sound/Noise originating from temporary construction sites as a result of construction activity are exempt fromthe noise linits
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 the
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
hannless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly fromthe issuance ofthis perrnit. Issuance ofthis pen -nit 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.
0 E-Sanitary Side Sewer Inspection
PARTIAL INSPECTION DATE: TMTIA L: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
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SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: po� FCC)+ ec
Site Contac . Phone#: �Ooe —7
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Mailing Address: 106-S- �
State License #: z oro R�5c ) -zz,
Expiration Date: 0 k g
City Business License A: NK
PROPERTY INFORMATION:
Address: � /C_) /0 go �), P L�j
Owner's Name: 6 /6 dc tp" I so
Phone#:
Fax #:
Email #:
-�Liability Insurance El Bonded
F-1 Full Line Replacement "Spot Repair 0 Pipe Burst El Reline (PermaLine Only)
DESCRIPTION OF PROPOSED WORK (Be Specific):
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SIGNATURE DATE
,—Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE