20181113151109.pdfCITY OF E,DMONIDS
c. l8
STATUS: APPLIED
I2I 5THAVENUENORTH - EDMONDS, V/A 98020
PHONE: (42s) 771-0220 - FAX: (42s) 771-u21
*PERMIT MUST BE POSTED ON JOBSITE*
8NG20180525
SIDE SEWER PERMIT t-s
Permit Number: EN G20 I 80525
Job Address:21909 84TH AVE'W, EDMONDS
Expiration Date: 0 1 /1 0 12019
APPLICANT CONTRACTOR
JIM DANDY ENT ERPRISES INC.
6202 2l4TH ST SW
EDMONDS, WA 98043
JIM DANDY ENTERPRISES INC.
6202 2l4TH ST SW
EDMONDS, WA 98043
(206)'.793-0ss7
LICENSE # : JIMDADES25KZ EXP:0510912020
PROPOSE TO RzuSE I-ATERAL
PROPOSE TO REUSE SIDE SEWER
LIDNI]MBER:
DRAINAGE
PROJECT CROSSES OTHER PRTVATE PROPERTY
VERIFICATION OF RECORDED EASEMENTS COMPLETE
INDEMMTY: The Applicant has signed an applicationwhich states he/she holds the City of Edmonds harmlessfom injuries,
damages or claints of any kind or descriptionwhaÍsoever,þreseen or unþreseen, that may be made against the CiÍy of Edmonds or
any of its departments or employees, including but not limiled Ío the defense of any legøl proceedings including defense cosÍs and
attorneyfees by reason of granting this permit.
CALL DIALA-DIG (1 -800 -424-5555) BF'ORE A¡rV Ð(CAVATION
CALL FOR rNS PECTION (42s) 7 7 t -0220 WT . 1326
24 HOUR NOTICEREQIIIRED FOR ALL INSPECTION REQUESÏS
RELEASEDBY DATE
Y N
N NN
REPAIR
GRINDERPUMP
4' spot repair with installation of clean out
N
N
JOB DESCRIPTION
EASEMM.{T INFORMATION
THIS APPL]CAT]ON IS NOT A PERMIT UNTIL SIGNED BY THE C]TY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PA]D, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Tues November l3 2018
APPLICATION APPROVAL
FILECOPY f msrucroRcoPY T APPLICANT COPY
CONTRACTOR INFORMATION:
Company Name:
Company Address:
City: i\À,0*
State License #
Expiration Date:6
PROPERTY INFORMATION:
SIDE SE\ilER
PERMIT APPLICATIOI{
Sitc Contact: f"lt i
fh Phone#: 49r,â116_36æ
Email #: )r¡\;
City Business License #-()
JrvnUAnÚ 3 hl483
Address: alqôq zur^O c,\
owner's Name:
|v1,r \te c\A@-91t63
n rur,r, LrNE REpLACEMENT M.spor REpATR n prpn BURST I nnuNn (pERMALINE oNLY)
DESCRIPTION OF PROPOSED WORK (Be Specific):
il
Llt
ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE PERMISSION TO V/ORK ON ANY PROPERTY OTHER
THAN THAT OWNED BY THE SUBJECT PROPERTY OV/NER.
CERTIFICATIONS NECESSARY FOR INSTALLATION METHODS ARE THE RESPONSIBILITY OF THE
CONTRACTOR PERFORMING SAID V/ORK.
I REPRESENT AND V/ARRANT 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
Contractor or Agent
zip:{¡ff+Ce.
SIGNATURE
NO WORK SHALL BEGIN PRIOR TO PERMIT TSSUANCE