ENG20150408.PDF� Of ^)4f CITY OF EDMONDS
121 5TH A VENUE NORTH - EDMONDS, WA 98020
Inc I890
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20150408
SIDE SEWER PERMIT (I -Single Family)
Permit Number: ENG20150408 Expiration Date: 12/30/2015
Job Address: 19026 OLYMPIC VIEW DR, EDMONDS
ROTO ROOTER ROTO ROOTER
16055 TUKWILA INT BLVD 16055 TUKWILA INT BLVD
TUKWILA, WA 98168 TUKWILA, WA 98168
(425) 2 18-4 120
LICENSE #: ROTORSC122BR EXP:
Y
N
i DESCRIPTION
I REPAIR N PROPOSE TO REUSE LATERAL LID NUMBER:
CRINDER PUMP N PROPOSE TO REUSE SIDE SEWER N DRAINACE
Dig down Tin the middle of the yard and replace T of sewer line, with a cleanout installed to serve upstream and downstream.
EASEMENTINFORNIATION
N
PROJECT CROSSES OTHER PRIVATE PROPERTY
N.
VERIFICATION OF RECORDED EASEMENTS COMPLETE
INDEMNITY. The Applicant has signed an application which states he/she holds the City of Edmonds harmless from injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may 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 DIALrA-DIG (1-800424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT.1326
24 HOUR NOTICE REQ UIRED FOR ALL INSPECTION REQUESTS
THIS APPLICATION IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Fritlay. October 02, 201
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DATE
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STATUS: ISSUED
ENG20150408
• Refer to City of Edmonds Side Sewer Information 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 permit 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 Div is ion 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 fi-omadjacent property owner is required prior to entry/work within adjacent property.
• Applicant shall repair/replace all damage to utilities or frontage unprovements 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 7:00am to 6:OOpm on weekdays and 10:00am and 6:OOpm 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 damages of
whatever nature, arising directly or indirectly from the issuance of this permit. 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 Sanitary Side Sewer Inspection
PARTIAL INSPECTION DATE: INITIAL:
PARTIAL INSPECTION DATE: INITIAL:
FINAL INSPECTION APPROVED DATE: INITIAL:
NOTES:
NOTES:
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"VC. I B90
SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: Eoia
Site Contact: &Cyc Sr^)i�& Phone #: t� _ Z19 --,-i�Z,O
Mailing Address: i �O �UKta,`� lw� Fax #:
State License #: go � 0 12SG 1 ZZ {3 Y�
Expiration Date:
City Business License #: � K _ azl z % 5
PROPERTY INFORMATION:
Address: 19
Email #:5k� C 1cl0--,0 kjkj aL l)A-,.Caw,
Q Liability Insurance Bonded
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Owner's Name:
Phone #: 9ty
❑ Full Line Replacement Spot Repair ❑ Pipe Burst ❑ Reline (PermaLine Only)
DESCRIPTION OF PROPOSED WORK (Be Specific) :
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SIGNATURE DATE /�-Z'- l.7
Contgfictor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE