2180_001.pdfCITY OF E,DMONIDS
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121 5THA\ÆNUENORTH- EDMONDS, WA 98020
PHONE: (425)77r0n0 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSI]ED ENG20190410
SIDE SEWBR PBRM IT I
Pennit Nr¡nùer: ENG20 I 904 1 0
Job Address: 81 8 POPLAR WAY EDMONDS
Expiration Date: 09 124 120 19
APPLIC,{NT CONTRACTOR
SEWER FRIENDLY
23930 HIGHWAY 99
EDMONDS, WA 98026
SEWER FRIENDLY
23930 HIGH'WAY 99
EDMONDS, WA 98026
(206) 93r-8r61
LICENSE #: SEWERSLI 96MS F.XP: O7 llÙl2\20
PROPOSE TO RzuSE I/.TERAL
PROPOSE TO RzuSE SIDE SEWER
LIDNLIMBER
DRAINAGE
PROJECT CROSSES OTHER PRTVATE PROPERTY
VERIFICATION OF RECORDED EASEMENTS COMPLETE
INDEMMTY: The Applicant has signed an application which states he/she holds the City of Edmonds harmless from iniuries,
damages or claims of any kind or description whatsoever,þreseen or unþreseetx, that mny be made against the City of Edmonds or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorney fees by reason ofgranting this permit.
CALL DIALA-DIG (l -800 424-5555) BBOREANY D(CAVATION
CALL FOR TNSPDCTION (42s) 7 7 l-0220 Ð(T. 1326
24 HOUR NOTICERBQUIRED FOR ALL INSPECTION REQUESTS
DATE
Y N
NNN
REPAIR
CRINDERPUMP
spot repair at house to install clean out
N
N
.IOB DF^SCRII'TION
EASUUB{T INTURMATION
THIS APPLICATTON ISNOTA PERMITUNTIL SIGNED BY THE CIry ENGINEERORHIS/HERDEPUTY: AND FEESARE PAID,AND RECEIPTISACKNOWLEDGED IN
SPACE PROVIDED.
201Printed:
,\PPLICAT¡ON,\PPROVAL
F'TLECOPY f nvsrncroRcoPY fu o*rrr.ANrcoPY
CONTRACTOR INFORMATION:
Company Name:je,,",-rr Ð;
Company Address:¿/)I?
City:
State License # Se*ef
SIDE SEWER
PERMIT APPLICATIOI\
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Expiration Date: 7- | 0 ->l
Site Contact:
Phone #:tl )s -q zaÌ13 7
zipz Qf,V2{ Email#:@- rS
City Business License #
- 010
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PROPERTY INFORMATION:
lo, vAddress:
Ownerts Name:
IF 4
4ì1e- C4/--
Phone#: ,4> S- 7J7- L/6_S I
E rull LINE REpLACEMENT K*ot REPAIR n prpn BURST E nrn¡w eERMALINE oNLY)
DESCRIPTION OF PROPOSED WORK (Be Specific):
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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 V/ARRANT TO THE CITY OF EDMONDS, IF REPAIR OF EXISTING SE'WER EXTENDS TO AN
ADJACENT PROPERTY, I HAVE O\ryNERS EXPRESS PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY.
SIGNATURE
Contractor or Agent
Ø4 DArE f-v 7-/
NO WORI( SHALL BEGIN PRIOR TO PERMIT ISSUANCE