20180927134137.pdf01; Ij)4
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 ENG20180417
SIDE SEWER PERMIT (]-Single Fa"ly)
Permit Number: ENG20180417 Expiration Date: 11 /27/2018
Job Address: 1143 C AVE S, EDMONDS
APPLICANT CONTRACTOR
PRICOR TECHNOLOGIES PRICOR TECHNOLOGIES
2825 S 154TH ST 2825 S 154TH ST
SEATAC, WA 98188
SEATAC,WA 98189
(253) 508-0460
LICENSE #: PRICOTL865KZ EXP: 05/09/2020
N
JOB DESCRIPTION
]REPAIR N PROPOSE TO REUSE LATERAL LIDNUMBER:
I GRINDER PUMP N I PROPOSE TO REUSE SIDE SEWER E—N 1 DRAINAGE
5'spot repair with cleanout to be installed.
EASEMENTINFORMATION
Nd
PROJEC17 CROSSES OTHER PRIVATE PROPERTY
N
'VERIFICATION OF RECORDED EASEMENTS COMPLETE
IA7)EMATTY- The Applicant has signed an application ivhich states helshe holds the City ofEdmonds harmlessftom injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City ofEdmonds or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
atforneyfees by reason ofgranting thispermil.
CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTTCEREQUIRED FOR ALL INSPECTION REQUESTS
APPLICATION APPROVAL
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HISMER DEPUTY AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED. Printed: Thursday, September 7 2LO19
RELEA
TE
E] FILE COPY F-] INSPECTOR COPY F-] APPLICANT COPY
STATUS: ISSUED
ENG20180417
• 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 Divis ion at 425-771-0235.
• Condition of the existing s anitary s ide sewer to be verified prior to obtain ing approval for reus e. TV inspection required. Video
to be submitted to City for review.
• Eas ement and/or pertnis s ion fi-om adjacent property owner is required prior to entry/work within adjacent property.
• Applicant shall repah-/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.
• Own er/Contractor to provide Side Sewer as built at final ins pection. See City Standards for requirements.
• Sound/Nois e originating from temporary construction s ites as a result of construction activity are exempt from the n ois e limits
of ECC Ch apter 5.30 only during the hours of 7:00am to 6:00pm on weekdays an d I 0:00am and 6:00pm on Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originating fi-ont construction sites /activities must comply with the
noise limits of Chapter 5.30, unless a variance has been granted pursuant to EJCC 5.30.120.
• Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
han-nIess the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly fi-om the issuance ofthis perrnit. Issuance of this pern-tit 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.
I INS PECTIONS
• E-Sewer Asbuilt
• E-Sanitaty Side Sewer Inspection
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
of EvAfo4l,
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INC. loo
SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name:
�rlt—r IC11,1.1-,,Le�
Site Contact:
Company Address: Phone #: 2 S3 - 509 -of�, (9
city: � ( Zip: �Ig I
State License # )r1g -[( or v
Expiration Date: 5/ci /)o
Email #:
City Business License # 0-(2)5)1�
PROPERTY INFORMATION:
Address: / � I � C, A ve-
Owner's Name: ) -, CA
Phone #: 42-5-774--�6-11
FULL LINE REPLACEMENT V SPOT REPAIR PIPE BURST RELINE (PERMALINE ONLY)
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DESCRIPTION OF PROPOSED WORK (Be Specific):
5 , 34, . / " IT I- I' tk �o . -1\ 5 �, /)
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 CITYOF EDMONDS, IF REPAIR OF EXISTING SEWER EXTENDS TO AN
ADJACENT PROPERTY, I PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY.
SIGNATURE ::zv7xPREss DATE U;711y-
ContKactor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE