ENG20170023 PERMIT-APP.pdfMONDS
.
121 5TH A VENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20170023
SIDE SEWER PERMIT _,.
Permit Number: ENG20170023 Expiration Date: 04/18/2017
Job Address: 17110 67TH AVE W EDMONDS
RESCUE ROOTER
175-A ROY RD SW
PACIFIC, WA 98047
RESCUE ROOTER
175-A ROY RD SW
PACIFIC, WA 98047
(253)405-7467
T.TCF.NSF #- RFSC I1R007C'97 F.XP- 01 /01 /2017
IADEMATTY.• 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 ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorney fees by reason ofgranting this permil.
CALL DIAL A-DIG(1-800-424-5555) BEFORE ANY EXCAVATION
CALL FORINSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTTCEREQUIRED FOR ALL INSPECTION REQUESTS
THIS APPLICATION IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED
REI EA SID BY
Printed:
DATE
FILE COPY INSPECTOR COPY APPLICANT COPY
2017
Y
N
REPAIR N PROPOSE TO REUSE LATERAL LID NUMBER:
GRINDER PUMP N I PROPOSE TO REUSE SIDE SEWER N DRAINAGE
SPOT REPAIR
EMENT INFORMATION
N I PROJECT CROSSES OTHER PRIVATE PROPERTY
N VERIFICATION OF RECORDED EASEMENTS COMPLETE
IADEMATTY.• 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 ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorney fees by reason ofgranting this permil.
CALL DIAL A-DIG(1-800-424-5555) BEFORE ANY EXCAVATION
CALL FORINSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTTCEREQUIRED FOR ALL INSPECTION REQUESTS
THIS APPLICATION IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED
REI EA SID BY
Printed:
DATE
FILE COPY INSPECTOR COPY APPLICANT COPY
2017
STATUS: ISSUED
ENG2O170O23
• 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 ebsting 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 sewerto be verified priorto 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 exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 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 fromthe issuance ofthis 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: NOTES:
PARTIAL INSPECTION DATE: INITIAL:¶ NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL: