20190325104957.pdfOV. EbAf
0 CITY OF EDMONDS
1215THAVENUENORTH- EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20190107
SIDE SEWER PERMIT (I -Single Family)
Permit Number; ENG20 190107 Expiration Date: 051123112019
Job Address: 9429 190TH PL SW, 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
N
JOB DESCRIPTION
]REPAIR N P TOREUSELATERAL LIDNUMBER:
I GRINDER PUMP N I PROPOSE TO REUSE SIDE SEWER F-71 DRAINAGE
158 ST OF PIPE BURSTING WITH HTPE 4"
EASEMENT INFORMATION
Nd
PROIEC71 CROSSES OTHER PRIVATE PROPERTY
N
VERIFICATION OF RECORDED EASEMENTS COMPLETE
IADEMNITY- 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 ofEdinonds or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorneyfees by reason ofgranting this permit.
CALL DIALA-DIG (1 -800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NO'nCEREQUIRED FOR ALL INSPECUON REQUEST'S
THIS APPLICATION IS NOT A PERNCTUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HERDEPUTY- AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROXIDED.
Printed: Monday, March 25,201
DA
F] FILECOPY F1 INSPECTORCOPY M APPLICANT COPY
STATUS: ISSUED
ENG20190107
• Refer to City of Edmonds Side Sewer Information h an dout 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 perrnit is required for work within the City right-of-way.
• Condition of the eAsting 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 sewerto be verified prior to obtaining approval for reuse. TVinspection required. Video
to be submitted to City for review.
• Easement and/or pcnrission fi-om-adjacerft pxoperty owneLis-fequired 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/Contractor to 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 7:00arn to 6:00pm on weekdays and 10:00am and 6:00pm 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 indemnify defend and hold
harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for darnages of
whatever nature, arising directly or indirectly from the issuance ofthis permit. 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.
[NSPECTIONS
0 E-Sanitary Side Sewer Inspection
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
of EVA404,
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CONTRACTOR INFORMATION:
Company Name:
SIDE SEWER
PERMIT APPLICATION
Site Contact:
Company Address: Phone #:
6449e
CRY:- , - zip: Email #:
State License #
Expiration Date:
PROPERTY INFORMATION:
City Business License # R 0,T6? 1,?- 7 f3
Address: P( (-:?
CIL(zy / C/(;) , �:: SW C-(SvvL0,o/65 wik e?s�-oz-
Owner's Name: P x 1P (N I/ rg cz- �-J!z
Phone #:
FULL LINE REPLACEMENT El SPOT REPAIR
DESCRIPTION OF PROPOSED WORK (Be Specific):
PIPE BURST
El RELINE (PERMALINE ONLY)
/7( rP Z'
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 EXPRESS PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY.
SIGNATURE DATE
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE