20190726084153.pdfCITY OF EDMONDS
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I21 5TH A\ÆNUENORTH - EDMONDS, WA 98020
PHONE: (425)77r0n0 - FAX: (425) 771-022r
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSTIED ENG20190351
Permit Nurnber: ENG20 1 903 5 I Expiration Date: 09 126 120 19
Job Address : 417 4THAVE N EDMONDS
MIKES PLUMBING
I 97 1 5 SCRIBER LAKE RD
.MIKES
PLUMBING
I 97 I 5 SCRIBER LAKE RD
LYNNWOOD, WA 98036 LYNNWOOD, WA 98036
(206) 794-934r
LICENSE#: MIKESPC99OKM ExP:0511212021
PROPOSE TO RzuSE T-ATERAL
PROPOSE TO REUSE SIDE SEWER
LIDNUMBER
DRAINAGE
PROJECT CROSSES OTHER PRIVATE PROPERTY
VERIFICATION OF RECORDED EASEMENTS COMPLETE
INDEMMTY: The Applicant has signed an application which states he/she holds the City of Edmonds harmless from injuries,
damages or claims of any kind or description whatsoever,þreseen or unþreseen, that may be made against the City of Edmonds or
any ofits departments or employees, including but not lintited to the defense ofany legal proceeding.s including defense costs and
a t t o rn ey fees b), re as o n of g rant i n g t h i s p ermí t.
CALL DIALA-DIG (l -800 424-5555) BEFOREANy D(CAVATTON
CALL FOR TNSPTTrON (42s) 7 7 r-0220 D(T. 1326
24 HO UR NO TIC E REQ UIRED FO R ALL INS PECTIO N REQ UFSTS
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BY DATE
SIDB SEWER PERMIT (1-Single Family)
APPI,ICANT CONTRACT()R
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REPAIR
G.INDERPT]MP N N
Spot repair in the middle of the back yard, applox 3'
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.IOB DESCRIP'TION
E.AS FJ\{ENT INFORNTATIO N
THISAPPLICATON ISNOTA PERMITUNTIL SIGNED BY TT]E CIry ENGINEERORHIS/HERDEPUry: AND FEESARE PAID,AND RECEIPTISACKNOWLEDGED IN
SPACE PROVIDED.
Printed 201
APPLICATION ,{PPROVAL
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StDB SEWER PERMIT (l-Single Family)
CON'DITIONS
STATUS: ISSUED 8NG20190351
o Refer to City of Ednnnds Side Sewer Infonrntion handout for approved pþe rnatenals, inspections and other requirenrents.
r A 6" cleanout with 12" locking cast iron larrphole cover is required at the property line.
¡ Maintain l0'separation between the sanitary side sewer and the water service line.
r A separate right-oÊway construction permit is required forworkwithin the City rþht-oÊway.
. C.ondition of the existing lateral to be verified by the City's Public Works Dept. to obtain approval for reuse. Contact Edrnonds
Sewer Division at 425-771-0235.
o Condition ofthe existing sanitary side sewerto be verified priorto obtaining approval forreuse. TVinspection required. Mdeo
to be submitted to City for review.
o Easernent and/or permis sion from adjacent property owner is required prior to entry/work within adjacent property.
. Applicant shall repair/replace all danrage to utilities or fiontage inprovenrents in City rightoÊway per City standards that is
caused by or occurs during the permitted project.
¡ Or¡mer/Contractor to provide Side Sewer asbuilt at final inspection. See City Standards for requirements.
¡ Sound/llloise originating fromterrporary construction sites as a result of construction activity are e)€npt fromthe noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 6:00pmon weekdays and l0:00amand 6:00pmon Saturdays, excluding
Sundays and Federal Holidays. At all othertirnes the noise originating fromconstruction sites/activities rn¡st conply 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 orher spouse, heirs, assigns, and successors in interests, agrees to inderrnify defend and hold
harnrless the City of Edrncnds, Vy'ashington, its ofücials, enployees, and agents fromany and all clainrs for dannges of
whatever nature, aris ing directly or indirectly from the issuance of this permit. Issuance of this permit shall not be deenred to
nndifu, waive or reduce any requirenænts of any City ordinance not limit in any way the City's ability to enforce any ordinance
provision.
E-Sanitary Side Sewer Inspection
PARTIALINSPECTION DATE:INITIAL:NOTES
NOTESPARTIALINSPECTIONDATE:INITIAL:
FINALINSPECTIONAPPROVED DATE:INITIAL:
TNSPECTIONS
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SIDE SEWER
PERMIT APPLICATION
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CONTRACTOR TION:
Company Name:
Company Address:
City:
Site Contact:
Phone #
Email #:
City Business #
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zip Cn/Y
State License #
Expiration Date:
PROPERTY INFORMATION:
14
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Ownerts Name:
Phone #:
E TUIT, LINE REPLACEMENT
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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 WORK.
I REPRESENT AND TO THE CITY OF EDMONDS, IF REPAIR OF EXISTING SEWER EXTENDS TO AN
ADJACENT PROPERTY, I OWNERS EXPRESS PERMISSION TO PERFORM V/ORK ON THAT ADJACENT
PROPERTY
V zú -1frDATE
Contractor or Agent
SIGNATURE
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE