20190321105606.pdfOV- QAI
CITY OF EDMONDS
1215THAVENUENORTH- EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20190103
SIDE SEWER PERMIT (1-Sin'-fe Family)
rel-j- -,I I T-Lil-A-ei- 11T I III 1 11111 11" nj 0
1 1 Expira-tion Da+L%-,-
It 114 ID . F-JN%-J/-U I YVI Uj E
Job Address: 21211 92ND PL W, EDMONDS
APPLICANT CONTRACTOR
ROTO-ROOTER ROTO-ROOTER
20508 56TH AVE W SUITE C 20508 56TH AVE W SUITE C
LYNNWOOD, WA 98036 LYNNWOOD, WA 98036
(206) 63 3-5 5 00
LICENSE #: ROTORSC122BR EXP: 04/03/2020
*
*
JOB DESCRIPTION
REPAIR N PROPOS TOREUSELATERAL LID NUMBER:
GRINDER PUMP N I PROPOSE TO REUSE SIDE SEWER F7N DRAINAGE
Small repair, appro3dmately 4 ft
LASEMENTINFORNIATION
Nd
PROIECT CROSSES OTHER PRIVATE PROPERTY
N
VERIFICATION OF RECORDED EASEMENTS COMPLETE
IADEMNITY- The Applicant has signed an application which states helshe holds the City ofEdmonds harmlessfrom injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City ofEdinonds or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
atiorneyfees by reason ofgranfing this permit.
CALL DIALA-DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOT'ICEREQUIRED FOR ALL INSPECTION REQUESTS
A
APPLICATION APPROVAL
THIS APPLICATION IS NOT A PERNITF UNTIL SIGNED BY THE CITY ENGINEER OR HISMER DEPUTY AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Thursday, March 21, 2019
RELEASED BY
DATE
E] FILE COPY F INSPECTOR COPY F APPLICANT COPY
STATUS: ISSUED
ENG20190103
* Refer to City of Edmonds Side Sewer In fon-nation handout for approved pipe materials, inspections and other requirements.
* A 6" cleanout with 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 pennit is required for work within the City right-of-way.
* Condition of the e)dsting 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 e)dsting 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 permission from adjacent property owner is required prior to entry/work within adjacent 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 Chapter 5.30 only during the hours of 7:00amto 6:00pm on weekdays and 10:00am and 6:00prn on Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must comply with 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 indenin4 defend and hold
hanniess the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly fi-om the issuance ofthis pen -nit. Issuance of this pen -nit 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: INITIAL:
PARTIAL INSPECTION DATE: INITIAL:
FINAL INSPECTION APPROVED DATE: INITIAL:
NOTES:
NOTES:
OfEDMO
1v<4
I&C. 1 scio
CONTRACTOR INFORMATION:
SIDE SEWER
PERMIT APPLICATION
Company Name: R , -4.., rzoo -/-� Site Contact: Xf- � 5
Company Address: -6601 7 L4 5 Phone#: �Z-Y'3Ve-00-?-7
City: 5e4h%2 Zip: Email #:
State License # Rol-of?SC I-ezf3k City Business License #
Expiration Date:
PROPERTY INFORMATION:
Address: -L / V1
t1mg PL L-^j
Owner's Name: �-o Y-1
Phone #:
FULL LINE REPLACEMENTZt, SPOT REPAIR PIPE BURST RELINE (PERMALINE ONLY)
DESCRIPTION OF PROPOSED WORK (Be Specific):
1,zeA, kzse- fitvr,,�,
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, I HAVE OWNERS EXP ESS PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY.
SIGNATUR: DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE