ENG20160516.PDFOF E DM0�O
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
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PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20160516
SIDE SEWER PERMIT (I -Single Family)
Permit Number: ENG20160516 Expiration Date: 02/27/2016
Job Address: 19211 OLYMPIC VIEW DR, EDMONDS
MR. ROOTER PLUMBING AND HEATING
2000 S 116TH Sr
SEATTLE, WA
MR. ROOTER PLUMBING AND HEATING
2000 S 1 16TH ST
SEATTLE, WA
(253)720-0792
1 '
1CF.NSF # MRROnF*022NF FXP• OR/19/201R
NY
JOB DESCRIPTION
IR N PROPOSE TO REUSE LATERAL LID NUMBER:
GRINDER PUMP N PROPOSE TO REUSE SIDE SEWER FN7 DRAINAGE
Side
sewer repair (approx 10') with cure in place liner (Pemlaliner will be used).
LkSFAIENTINFORNIATION
N
PROJECT CROSSES OTHER PRIVATE PROPERTY
N
VERIFICATION OF RECORDED EASEMENTS COMPLETE
1ADEMMTY 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, foreseen or unforeseen, that may be made against the City of Edmonds or
any ofils 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 DIAL -A -DIG (l-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT.1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
THIS APPLICATION IS NOTA PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED.
• �.
Printed: Tuesday, December 27, 201
DATE
❑ INSPECTOR COPY ❑ APPLICANT COPY
Q
STATUS: ISSUED
ENG2016O516
• 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 e)asting 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 e)asting 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/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 exrmpt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:OOam 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 ofthis permit. Issuance ofthis 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-Water Test & TV
• E-Asbuilt
• E-Sanitary 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: P-A lUju-
Mailing Address:
.2.OD0 S
State License #: M (ZPXp7j�-O22A%E-
Expiration Date: V I of / 11K
City Business License #: o22'Z
PROPERTY INFORMATION:
Phone #:
Fax #:
Email #: rny-r G, . C�
Q Liability Insurance Bonded
Address:
Owner's Name: m l Ck) _ SU w , M ` I IP -
Phone #: (�
❑ Full Line Replacement ❑ Spot Repair ❑ Pipe Burst ►VReline (PermaLine Only)
DESCRIPTION OF PROPOSED WORK (Be Specific) :
n '(21 IIrLU
SIGNATUR DATE 1,,-?-Zo-7 Lt t,
Contractor Age t
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
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