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CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERN11T MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20190097
SIDE SEWER PERMIT (]-Single Fanifly)
Peniih Number: ENG20190097 Exp iratio r, D ate .- 0 _5 6 //21 0 11 9
Job Address: 848 PUGET WAY, EDMONDS
APPLICANT CONTRACTOR
DIGIT EXCAVATION DIGIT EXCAVATION
910 156TH ST NE 910 156TH ST NE
ARLINGTON, WA 98223
ARLINGTON, WA 98223
(425) 239-7449
LICENSE #-. DIFITE1999RC EXP: 12/31/2019
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JOB DESCRIPTION
JREPATR N PROP TOREUSELATERAL I -ID NUMBER:
I GRINDER PUMP N I PROPOSE TO REUSE SIDE SEWER FN 1 DRAINAGE
SEWER LINE REPLACEMENT- HOUSE TO MAIN
EASEMENTINFORMATION
PROJECT CROSSES OTHER PRIVATE PROPERFY
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VERIFICATION OF RECORDED EASEMENTS COMPLETE
IADEMNITY- The Applicant has signed an application which states helshe holds the City ofEdmonds harmlessfi-om injuries,
damages or claims ofany kind or description whalsoever, foreseen or unforeseen, that may be made against the City ofEdmonds or
any of its departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorneyfees by reason ofgranting thispermit.
CALL DIAL-A-DIG(1-800424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NO-110EREQUIRED FOR ALL INSPECTION REQUESTS
THIS APPLICATION IS NOTA PERMITUNUL SIGNED BY THE CITY ENGINEER OR HISMERDEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Mondav, March
-13
DATE
F FILE COPY F—] INS PECTOR COPY F APPLICANT COPY
STATUS: ISSUED
ENG20190097
• 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 larriphole 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 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 of the existing sanitary side sewer to be verified prior to obtaining approval for reuse. TV inspection required. Video
to be submitted to City for review.
• Easement and/or pennission fi-orn adjacent property owner is required prior to entry/work within adjacent property.
• Applicant shall repair/replace all daimge to utilities or fi-ontage improvements in City right-of-way per City standards that is
caused by or occurs during the pennitted project.
• Owner/Contractorto provide Side Sewer asbuilt at final inspection. See City Standards for requirements.
• Sound/Noise originating fromteniporary construction sites as a result of construction activity are exempt fromthe noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 6:00pmon weekdays and 10:00amand 6:00pmon Saturdays, excluding
Sundays and Federal Holidays. At all othertimes the noise originating from construction sites /activities must complyMth the
noise limits 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
harmless the City of Edmonds, Washington, its officials, employees, and agents firomany and all claims for damages of
whatever nature, arising directly or indirectly fromthe issuance of this permit. Issuance of this pennit 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.
0 E-Sanitary Side Sewer Inspection
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NGTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
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CONTRACTOR INFORMATION:
SIDE SEWER
PERMIT APPLICATION
Company Name: Ili., -3:� ��Ccwm4c SiteContact: e��(
Company Address: Phone #: qZ!;. Z3 7- 7Y9V!
q4a 15-C-ST A14C
City: zip: 2igz 2 3
State License #
Expiration Date:
PROPERTY INFORMATION:
Address: a C/E
Owner's Name:
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Email #:
City Business License #
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Phone #:
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eFULL LINE REPLACEMENT Fl SPOT REPAIR F1 PIPE BURST El RELINE (PERMALINE ONLY)
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DESCRIPTION OF PROPOSED WORK (Be Specific):
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 CITY OF EDMONDS, IF REPAIR OF EXISTING SEWER EXTENDS TO AN
ADJACENT PROPERTY, 1 HAVE OWNERS EXPRESS PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY.
SIGNATURE 7Z DATE 4?
Contractor orAgent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE