20170621085847.pdf0
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20170247
SIDE SEWER PERMIT (I -Single Family)
Permit Number: ENG20170247 Expiration Date: 06/21/2018
Job Address: 530 4TH AVE S, EDMONDS
�APPLICANT CONTRACTOR
ACESFOUR ACES FOUR for Infrasource
18008 BELLFLOWER RD 18008 BELLFLOWER RD
BOTHELL, WA 98012
BOTHELL, WA 98012
(206) 62 2-83 3 7
LICENSE 4: ACESFCCO I 4NW EXP: 05/01/2018
-_Y�REPAIR
N
JOB DF.SCRIPTION
N PROPOSE TO REUSE LATERAL LIDNUM13ER:
I GRINDER PUMP N I PROPOSE TO REUSE SIDE SEWER F-7-1 DRAINAGE
emergency repair sewer line
I
LAS EMENT INFORMATION
Nd
PROJECT CROSSES OTHER PRIVATE PROPERTY
N
VERIFICATION OF RECORDED EASEMENTS COMPLETE
I
IADEMATTY- The Applicant has signed an application ivhich states helshe holds the City ofEdmonds harmlessfrom injuries,
damages or claims ofany kind or description ivhafsoever, foreseen or unforeseen, that may be made against the City ofEdnionds or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
afforneyfees by reason ofgranting this permit.
CALL DIALA-DIG (1 -800-424-5555) BEFOREANV EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTTCEREQUIRED FOR ALL INSPECTTON REQUESTS
TT-HS APPLICATION IS NOT A PERMT UNTIL SIGNED BY THE CITY ENGINEER OR HISMER DEPUTY AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PRONADED.
I'm
Printed: Wednesdav, June 21, 201
DATE
M� FILE COPY INSPECTOR COPY APPLICANT COPY
STATUS: ISSUED
ENG20170247
• Refer to City of Edmonds Side Sewer In formation handout for approved pipe materials, inspections and other requirements.
• A 6" cleanout with 12" locking cast iron larnphole cover is required at the property line.
• Maintain 10'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 ofthe 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 ofthe existing sanitary side sewer to be verified prior to 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 fromtemporary construction sites as a result of construction activity are exempt from the noise limits
of ECC Cliapter 5.30 only during the hours of 7:00am to 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 ofhis 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 clairfis for damages of
whatever nature, arising directly or indirectly fromthe issuance ofthis 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.
0 E-San itary Sid e Sewer In s pection
PARTIALINSPEMON
PARTIAL INSPECTION
FINAL INSPECTION APPROVED
DATE: INITIAL:
DATE: INITIAL:
DATE: INITIAL:
NOTES:
NOTES:
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SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Nam C —
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Site Contact: Phone#:
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State License #: L4 1N
Expiration Date: Email 4:
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City Business License b: —ULiability Insurance Bonded
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PROPERTY INFORMATION:
Address: SS6 :1 --7
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Owner's Name:
Phone#:
F-1 Full Line Replacement 5� Spot Repair 0 Pipe Burst [:1 Reline (PermaLine Only)
DESCRIPTION OF PROPOSED WORK (Be Specific):
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SIGNATURE -A� �� DATE 6,LR / ZI
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE