2179_001.pdfCITY OF EDMONDS
I2I 5TH AVENUENORTH - EDMONDS, WA 98020
PHONE: (425)771-0220 - FAX:(42s) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED 8NG20190409
FaSIDE SEWER PERMIT I
Permit Number: ENG20 1 90409
Job Address:9605 2I4TFI PL S EDMONDS
Exp iration Date : 09 I I I I 20 I 9
CONTRACTORAPPLICANT
JIM DANDY SEWER
903 N I28TH ST
JIM DANDY SEWER
903 N I28TH ST
SEATTLE, WA 98020 SEATTLE, WA 98020
(425) 346-7332
LICENSE #:imdad5879b3 EXP: 05/09/2020
TOREUSELATERAL
TORzuSESIDESEWER
LIDNUMBER:
DRAINACE
PROJECT CROSSES OTHER PRIVATE PROPERTY
TION OF RECORDED EASEI\4ENTS COMPLETE
INDEMMTY: The Applicant has signed an applicaÍion which states he/she holds the City of Edmonds harmlessfrom injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, ÍhaÍ may be made againsf the City ofEdmonds or
any ofits departments or employees, including but not limited to the deþnse ofany legal proceedings including defense cosî's and
attorney fees by reason ofgranÍing this permit.
CALL DIALA-DIG (1 -800 -424-5555) BB'ORE Alr[Y Ð(CAVATION
CALL FOR TNSPECTION (425) 7 7 l-0220 D(T. I 326
24 HOUR NOTICEREQUIRÐ FOR ALL INSPBCTION REQUESTS
DATE
Y N
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REPAIR
(RINDERPUMP
REPAIR BELLY IN LINE, APPROX 12 FOOT REPAIR
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.IOB DLSCRIPTION
EAS EMD..,I T TN FO RMATION
THIS APPLICATION IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY; AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PRO\4DED.
^ ,\ r Printed: Tuesday, August 27,2019
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CONTRACTOR INFORMATION:
SIDE SEWER
PERMIT APPLICATION
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Expiration Date:
PROPERTY INFORMATION:
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Owner's Name:
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DESCRIPTION OF PROPOSED WORK (Be SpecifÏc):
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ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE PERMISSION TO WORK ON ANY PROPERTY OTHER
THAN THAT OV/NED BY THE SUBJECT PROPERTY O'VVNER.
CERTIFICATIONS NECESSARY FOR INSTALLATION METHODS ARE THE RESPONSIBILITY OF THE
CONTRACTOR PERFORMING SAID V/ORK.
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 DA
or Agent
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NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE