20190307121557.pdfCITY OF E,DMO}{DS
c. l8
I21sTH AVENT'ENORTH - EDMONDS, V/A 98020
PHONE: (425) 77 1 -0220 - FAX: (425) 77 l-0221
*PE,RMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED 8NG20190084
FaSIDE SE,WER PERMIT l-s
Permit Number: ENG20 1 90084
Job Address:21700 96TH AVE W E,DMONDS
Expiration Date: 05/l 0 1201 9
APPLICANT CONTRACTOR
SEWER FRIENDLY
23930 HIGHWAY 99
SEWER FRIENDLY
23930 HIGHWAY 99
EDMONDS, WA 98026 EDMONDS, WA 98026
(206) 931-816r
LICENSE #: SEWERFLl96MS El{P 07/1012019
PROPOSE TO REUSE LATERAL
PROPOSE TO RzuSE SIDE SEV/ER
LIDNUMBER:
DRAINAGE
PROJECT CROSSES OTHER PRIVA TE PROPERTY
VERIFICATION OF RECORDED EASEMENTS COMPLETE
INDEMMTY: The Applicanl has signed an applicafion which sîates he/she holds the City of Edmonds harmless i'om injuries,
damages or claims of any kind or descripÍion y,hatsoeyer,foreseen or unþreseen, thal nmy be made againsf the City of Ednronds or
any ofits departrnents or employees, including but nol linited to fhe defense ofany legal proceedings including defense costs and
a|Íorneyfees by reason ofgranting lhis permit.
CALL DIALA-DrG (1 -800 -42 4-555s) BmORE ANY Ð(CAVATION
CALL FOR INSPECTION (42s) 1 1 l -0220 D(T. I 326
24 HOUR NOTICEREQUIRÐ FOR ALL INSPECTION REQUESTS
SED DATE
N N
NNN
REPAIR
CRINDERPUMP
3 FT REPAIR
N
N
JOB DESCRTPTION
EASÛ\{MJT INFORMATION
THIS APPLICATON IS NOTA PERM1TUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed:Thurs March 07 2019
APPLICATION APPROVAL
I rrmcorv I nsrrcroRcoPY ! lruucANTCoPY
SIDE SE\ilER
PERMIT APPLICATIOI{
CONTRACTOR INFORMATION:
Company Name: SU¡site contact: L176 ^ 3Ø\ -3
CompanyAddress: BQTO ät")V Phone #:b - Ø90 .-1:"11t,
City:zivz qa6g75 Email#: B51o
State License # Sgt¡.1 Ë v FLqluf.{City Business License #
Expiration Date:
PROPERTY INFORMATION:
Address:Z "loo qbt\ FilÉ |.,J
Ownerts Name:
Phone #:
¡1 rur.r- LrNE RErLACEMENT 'trlspor RErATR ! rrpp BURST I nrr,rNn (PERMALINE ONLY)
I DESCRIPTION OF PROPOSED WORK (Be Specific):
Vt-
ISSUANCE OF THIS PERM]T DOES NOT CONSTITUTE PERMISSION TO WORK ON ANY PROPERTY OTHER
THAN THAT OWNED BY THE SIIBJECT 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
PROPERTY, I TO PERFORM WORK ON THAT ADJACENT
DArE 3^1-IqSIGNATURE
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE