20180927132742.pdfCITY OF EDMONDS
I21 5TH AVENUENORTH - EDMONDS, V/A 98020
PHONE: (425)771-0220 - FAX:(425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG2018 04t6
Permit Number: ENG20 I 804 1 6 Expiration Date: 1 112712018
Job Address:21421 92ND AVE W EDMONDS
2 142 I 92ND A\¡E W
EDMONDS, V/A 98020
21421 92NDAVEW
EDMONDS, WA 98020
(206) s9s-6s72
LICENSE #: EXP:
PROPOSE TO RzuSE LATERAL LIDNUMBER:
TORzuSESIDESEWER DRAINACE
PROJECT CROSSES OTHER PRIVA TE PROPERTY
TION OF RECORDED EASEMENTS COMPLETE
INDEMMTY: The Applicant has signed an application which staf es he/she holds the City of Edmonds harmlessfrom injuries,
damages or claims of any kind or description whatsoever,foreseen or unþreseen, f haf may be made againsî the City of Edmonds or
any ofits departmenls or entployees, including but not limited to lhe defense ofany legal proceedings including defense costs and
atÍorneyfees by reason ofgranfing fhis permil.
CALL DrALA-DIG (t -800-424-5555) BU'ORE,{WÐ(CAVATTON
CALL FOR TNSPECTION (425) 7 7 I -0220 D(T. I 326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
BY TE
SIDB SBWER PERMIT -Single Family)
APPLIC,ANT CONTRACTOR
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N
REPAIR
GRINDERPUMP N N
ddition of approx 20'of side sewerwith cleanout just outside ofthe structure
Y
N
JOB DESCRIPTION
EASEMÐ\T INFORMATION
THIS APPLICATION IS NOTA PERM.ITUNT]L SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
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SPACE PRO\4DED.
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SIDB SBWER PERMIT (l-Single Family)
CONDITIONS
STATUS: ISSUED ENG2018 0416
¡ Referto Cify ofRlmonds Side Sewerlnfomation handout forapproved pþe materials, inspections and otherrequirements.e A 6" cleanout with 12" locking cast iron lamphole cover is required at the propefiy line.
¡ Maintain l0'separation between the sanitary side sewer and the water seryice line.¡ A separate right-oÊway construction permit is required for work within the Cify right-oÊway.
. Condition of the existing 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 existing sanitary s ide sewer to be verified prior to obtaining approval for reuse. TV inspection required. Video
to be submitted to City for review.
r Easement andlor permission fi'om adjacent propefiy owner is required plior to entry/work within adjacent propeffy.
. Applicant shall repair/replace all danrage to utilities or frontage improvements in Cþ right-oÊway per City standards that is
caused by or occurs during the permitted project.
o Owner/Contl'actorto provide Side Sewer asbuilt at final inspection. See Cþ Standards for requirements.
o Sound/Noise originating fromtemporary construction sites as a result of construction activity are exempt fromthe noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 6:00pm on weekdays and l0:00am and 6:00pm on Satuldays, ercluding
SundaysandFederal Holidays. Atallothertimesthenoiseoriginatingfromconstructionsites/activitiesmustcompþwiththe
noise limits of Chapter 5.30, unless a variance has been granted pursuant 1o ECC 5.30.120.. Applicant, on behalf ofhis or her spouse, heirs, assigns, and successors in interests, agrees to indenmify defend and hold
harmless the City of &lmonds,'Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directþ or indirectþ from the issuance ofthis permit. Issuance of this pemit shall not be deemed to
nrodify, waive or reduce any requirements of any City ordinance not limit in any way the Cify's ability to enforce any ordinance
provision.
. E-Sewer Asbuilt¡ BSanitary Side Sewer Inspection
PARTIALINSPECTION
PARTIALINSPECTION
FINAL INSPECTION APPROVED
DATE:-
DATE:-
DATE:-
INITIA
INITIA
NOTES:_
NOTES:_
INITIAL:
TNSPECTIONS
SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name:
Company Address:
City
State License #
t
q Site Contact:
Phone#: Tt
Email #:Las
City Business License #
rvr
Expiration Date:
PROPERTY INFORMATION:
Address:
Owneros Name:
Phone #:
I rull LINE REILAcEMENT n spor REIATR n prpn BURST n nruNa (IERMALTNE oNLy)
DESCRIPTION OF PROPOSED WORK (Be Specific):
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ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE PERMISSION TO WORK ON ANY PROPERTY OTHER
THAN THAT OWNED BY THE SUBJECT PROPERTY OWNER.
CERTIFICATIONS NECESSARY FOR INSTALLATION METHODS ARE THE RESPONSIBILITY OF THE
CONTRACTOR PERFORMING SAID WORK.
I REPRESENT AND WARRANT TO THE CITY OF EDMONDS, IF REPAIR OF EXISTING SEWER EXTENDS TO AN
ADJACENT PROPERTY, I HAVE OWNERS EXPRESS PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY
DATE
Con or
AVl q O.tl E. L{.>
SIGNA
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE