5.29.19 - Issued permit.pdf0
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CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20190236
SIDE SEWER PERMIT (I -Single Family)
Permit Number: ENG20190236 Expiration Date: 07/29/2019
Job Address: 21731 95TH AVE W. EDMONDS
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Rescue Rooter
Rescue Rooter
175 Aroy Rd. S.W
175 Aroy Rd. S.W.
Suite 101
Suite 10 1
Pacific, WA 98047
Pacific, WA 98047
(206) 200-8257
LICENSE #� RESCUR*007Q7 EXP,
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REPAIR N PROPOSE TO REUSE LATERAL LID NUMBER:
GRINDER PUMP N I PROPOSE TO REUSE SIDE SEWER F—N-1 DRAINAGE
7repair
of 4" side sewer line and install of 4" cleanout.
EASEMENT INFORMATION
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PROIECT CROSSES OTHER PRIVATE PROPERTY
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VERIFICATION OF RECORDED EASEMENTS COMPLETE
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INDEMNITY- 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 ofEdmonds 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) BEFOREANY EXCAVATION
CALL FDR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECRON REQUEST'S
THIS APPLICATION IS NOT A PERMTUNTIL SIGNED BY THE CITY EN GfNEER OR HISMER DEPUTY AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PRON71DED
Printed: Wednesday. Mav 29.201
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F-I FILE COPY F-] INSPECTOR COPY F-1 APPUCANT COPY
STATUS: ISSUED
ENG20190236
• Refer to City of Edmonds Side Sewer Infon-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 pen -nit is required for work within the City right-of-way.
• Condition of the existing 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 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 fromtemporary construction sites as a result of construction activity are exempt fromthe noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 6:00pmon 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 Cbapter 5.30, unless avariance has been granted pursuant to ECC 5.30.120.
• Applicant, on behalf ofbis 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 damages of
whatever nature, arising directly or indirectly from the issuance of this pennit. Issuance of this permit 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.
• E-As-built
• E-San itary Side Sewer Inspection
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
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SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: Site Contact
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Company Address: 1 -15 A 9,o *1 9.1) -5. W Phone#: W 4) - us-1
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City: Vae- I WC4. zip: -
State License # Re fit %jel5n-7 0"1—
Expiration Date: (3 1 t 0 11 -LOZO
PROPERTY INFORMATION:
Email #:
City Business License #
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Address:
Owner's Name:
Phone #: 47-�; `7,4 8 9 4 -7 L
FULL LINE REPLACEMENT VSPOT REPAIR PIPE BURST El RELINE (PERMALINE 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 WARRANT TO THE CITY OF EDMONDS, IF REPAIR OF EXISTING SEWER EXTENDS TO AN
ADJACENT PROPERTY, 1 HAVE OWNERS EXPRESS PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY. DATE512.q I
SIGNATURE )L
*—'Co",trac�to,o, Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE