20190307121616.pdfCITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERNHT MUST BE POSTED ON JOBSTTE*
STATUS: ISSUED ENG20190084
SIDE SEWER PERMIT (]-Single Family)
Permit Number: E-NG20190084 E\piration Date: 05/10/2019
Job Address: 21700 96TH AVE W, EDMONDS
APPLICANT CONTRACTOR
SEWER FRIENDLY SEWER FRIENDLY
23930 HIGHWAY 99 23930 HIGHWAY 99
EDMONDS, WA 98026 EDMONDS, WA 98026
(206) 93 1-8 16 1
LICENSE 4: SEWERFL I 96MS EXP 07/10/2019
NdREPAIR
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JOB DESCRIPTION
--=TROPOSE TO REUSE LATERAL LIDNUMBER:
GRINDER PUMP N I PROPOSE TO REUSE SIDE SEWER F-71 DRA INA GE
3 FT REPAIR
LAS LMENT INFORMATION
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PROIE171 CROSSES OTHER PRIVATE PROPERTY
N
VERIFICATION OF RECORDED EASEMENTS COMPLETE
INDEMNITY- The Applicant has signed an application which 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 ofEdnionds or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
afforneyfees by reason ofgranting thispermil.
CALL DIALA-DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOUCEREQUIRED FOR ALL INSPEC-FION RFjQUESTN
THIS APPLICATION IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PRM/IDED.
SED
Printed: Thursday. March 07, 201
DATE
E] FILE COPY 1-1 INSPECTOR COPY F-] APPLICANT COPY
STATUS: ISSUED
ENG20190084
• Refer to City of Edmonds Side Sewer Information handout for approved pipe materials, inspections and other requirements.
• A 6" cleanout v6th 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 workwithin the City right-of-way.
• Condition ofthe 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 ofthe existing sanitary side sewerto be verified prior to obtaining approval for reuse. TVinspection required. Video
to b e s ub m:itted to City for rev iew.
• Eas eme n t an d/o r p ermis s io n tro in adjacent property owner is req u ired prior to entry/work VAth in adjacen t property.
• Applicant shall repair/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.
• Owner/Contractorto provide Side Sewer asbuilt at final inspection. See City Standards for requirements.
• Sound/Noise originating from temporary construction sites as a result of construction activity are exempt from the noise limits
of ECC Cliapter 5.30 only during the hours of 7:00am to 6:00pin on weekdays and 10:00arn and 6:00pin on Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must comply with tile
noise lirnits of Chapter 5.30, unless a variance has been granted pursuant to ECC 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 fi-orn any and all clairris for damages of
whatever nature, arising directly or indirectly fi-orn the issuance ofthis permit. Issuance of this permit 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.
a E-Sanitary Side Sewer Inspection
PARTIAL INSPECTION DATE:
PARTIAL INSPECTION DATE:
FINAL INSPECTION APPROVED DATE:
INITIAL: NOTES:
INITIAL: NOTES:
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of EDA40 4��
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CONTRACTOR INFORMATION:
Company Name:
SIDE SEWER
PERMIT APPLICATION
Site Contact: H26 - 3b � - 113
Company Address: - �W\,j Phone#: ZC)6- Cb9C)_ -TLJ-7C6
13 q 30
City: Zip: 4b Email#: U) M
State License # 5F-WEV-FLqN City Business License # RL010(
Expiration Date:
PROPERTY INFORMATION:
Address: 2-1100 W�
Owner's Name:
Phone #:
Fj FULL LINE REPLACEMENT 19SPOT REPAIR EIPIPEBURST El RELINE (PERMALINE ONLY)
DESCRIPTION OF PROPOSED WORK (Be Specific):
J
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 WARR-ANT TO THE CITY OF EDMONDS, IF REPAIR OF EXISTING SEWER EXTENDS TO AN
ADJACENT PROPERTY, I HAV S PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY.
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SIGNATURE ZW/0 DATE
— -/ tontra"o��gent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE