20181113112121.pdfCITY OF E,DMO}{DS
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STATUS: ISSUED
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425)771-0220 - FAX: (425)771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
ENG20180520
SIDE SEWBR PERMIT (l-Single Family)
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Job Address:21909 93RD AVE,EDMONDS
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APPLICANT CONTRACTOR
PRICOR
2825 S 154TH ST
PRICOR
2825 S I54TH ST
(206) 2s8-s270
LICENSE #: PRICOtÌ865k2 EXP: 05109/2020
PROPOSETO RzuSELATERAL
PROPOSE TO RzuSE SIDE SEWER
LIDNUMBER:
DRAINAG
PROJECT CROSSES OTHER PRIVA TE PROPERTY
VERIFICATION OF RECORDED EASEMENTS COMPLETE
INDEMMTY The Applicant has signed an applìcation vhich stafes he/she holds the City of Edmonds harmlessfrom injuries,
damages or claims of any kind or description vthatsoeyer,foreseen or unforeseen, lhaÍ nøy be made againsl the City of Edtnonds or
any ofits deparfments or employees, including but not limíted lo the defense ofany legal proceedings including defense costs and
attornelt.þes by reason of granting lhis permit.
CALL DIALA-DIG (1 -800-424-5555) BtrORE ArriY D(CAVATION
CALL FOR TNSPECTTON (425) 7 7 t-0220 Ð(T. I 326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTON REQUESTS
DATE
Y N
NNN
REPAIR
CRINDERPUMP
5 ft spot repair with c/o installation
N
N
JOB DESCRIPTION
EAS E\{B{T IN FO RMATION
TI]IS APPLICATION IS NOT A'PERMITUNTÍL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PRO\4DED.
Printed: Tues November 1 201
APPLICATION APPROVAL
I rn-ncorv INSPECTORCOPY ! annucANTCoPY
SIDE SE\ryER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name:lltt(4 lechn.lu ,'. 5
Site Contact:h
Company Address: LK f5 \t<4 </Phone #: ) 0l-l <g -S)7o
city, Je__L
State License #î.LofL Zé5 ciry Business License n lV K -0)Ð10 (,
Zipz g Email #:
ExpirationDate: S fl llCl
PROPERTY INFORMATION:
Address: tt ,lo j 7J'/Arc vP
Owner's Name: - i
I Aon^ S
(22
n rur,r, LINE RErLACEMENT fl sror REIATR n prpn BURST E nrlrNn (PERMALINE oNLY)
s
Phone #:06-2-l
DESCRIPTION OF PROPOSED WORK (Be Specific)1/t CO
ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE PERMISSION TO V/ORK 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 V/ORK.
I REPRESENT AND WARRANT TO THE OF EDMONDS, IF REPAIR OF EXISTING SEWER EXTENDS TO AN
ADJACENT PROPERTY, I EXPRESS PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY
DArE / //û.'
Contractor or Agent
SIGNATURE
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE