20170814112852.pdfOX
CITY OF EDMONDS
1215THAVENUENORTH- EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20170327
SIDE SEWER PERMIT (I -Single Family)
Permit Number: ENG20170327 Expiration Date: 10/13/2017
Job Address: 802 6TH AVE S, EDMONDS
Roto Rooter Roto Rooter
10655 Tulmfla International Blvd 10655 Tukwla International Blvd.
TukvAla,WA 98168 TukvA]a, WA 98168
(425) 417-8193
LICENSE #: rotorscl 22br EXP: 04/03/2018
*
*
JOB DF-SCRIPTION
REPAIR N PROPOSE TO REUSE LATERAL LIDNUMBER:
GRINDER PUMP N I PROPOSE TO REUSE SIDE SEWER F_N I DRAINAGE
Replacc5of4" line and install cleanout.
EAS EMENTINFORNIAT[ON
PROJECT CROSSES OTHER PRIVATE PROPERTY
IVERIFICATION OF RECORDED EASEMENTS COMPLETE
_N
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
atforneyfees by reason ofgranting this permit.
CALL DIAL -A -DIG (1 -800-424-5555) BEFORE ANYEXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NO'HCEREQUIRED FOR ALL INSPECTTON REQUESTS
THIS APPLICATION IS NOT A PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HISMER DEPUTY -AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
R L �RA
Printed: Monday. AuLuist 14.201
0
M
Ej FILE COPY F-1 INSPECTOR COPY F-] APPLICANT COPY
STATUS: ISSUED
ENG20170327
• 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 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 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 e)dsting sanitary side sewerto 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 from temporary construction sites as a result of construction activity are exempt from the noise limits
of ECC Chapter 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 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 ofthis permit. Issuance of this perrnit 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: fMTIAL: NOTES:
PARTIAL INSPECTION DATE: rMTIAL: NOTES:
FINAL INSPECTION APPROVED DATE: fMTIAL:
Of EVAto
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SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INF*RMATION:
Company Name: k 0�o -6 o k ,,
niiye t-onyacy: a pt 049 -1
Mailing Address:
StateLicense#: K01-0 K�r— t2-Z-5p,
Expiration Date: / A Ile
City Business License #: Xf e- — (0 Z, � 2-4 o
PROPERTY INFORMATION:
Address:
Owner's Name: rq 44
Phone #: v
F-1 Full Line Replacement �4pot Repair
Phone #: 4 2-15- 6 11- J /'� 3
Fax #:
Email #:
Liability Insurance L] Bonded
0 Pipe Burst 0 Reline (PermaLine Only)
DESCRIPTION OF PROPOSED WORK (Be Speciflc):
R,e P Iqc,- S, 0',
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q 01�& J4 C9 v �—
SIGNATURE DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE