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121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMITMUST BE POSTED ON JOBST.*
STATUS: ISSUED ENG20170064
SIDE SEWER PERMIT (11 -Single FatWly)i
Permit Number: ENG20170064 Expiration Date: 05/22/2017
Job Address: 19200 93RD PL W, EDMONDS
O.
SPOSART INC DBA MR, ROOTER PLUMBING SPOSART INC DBA MR ROOTER PLUMBING
2000 S 116TH ST 2000 S 116TH ST
SEATTLE, WA 98168 SEATTLE, WA 98168
(206)471-0164
LICENSE #: MRROOP*022NE EXP
REPAIR PROPOSE TO REUSE LATERAL LID NUMBER:
GRINDER PUMP r -N-1 PROPOSE TO REUSE SIDE SEWER ( -N 1 DRAINAGE
Spot repair (approx 6) near the house and install cleanout.
PROJECT CROSSES OTHER PRIVATE PROPERTY
VERIFICATION OF RECORDED EASEMENTS COMPLETE
7NDEMMTY 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 whalsoever, 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 DIAL -A-DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTTON REQUESTS
THIS APPLICATION IS NOTA PERNUTUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED
SED BY
Printed: Wednesday, February :22.201
DATE
❑ FILE COPY ❑ INSPECTOR COPY ❑ APPLICANT COPY
STATUS: ISSUED
ENG20170064
• 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 Division at 425-771-0235.
• Condition ofthe existing sanitary side sewerto 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 fi•ontage 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 from temporary construction sites as a result of construction activity are exempt fiomthe noise limits
of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on 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 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 fi•om any and all claims for damages of
whatever nature, arising directly or indirectly fromthe 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.
INSPECTIONS
• E -Sewer Asbuilt
• E- Sanitary Side Sewer Inspection
PARTIAL INSPECTION DATE: rMTIA L. NOTES:
PARTIAL INSPECTION DATE: INITIAL:
..... NOTES:
FINAL INSPECTION APPROVED DATE: --......_............... �._._.
INITIAL:
0'N,rRAc-r0R INI ORMATION:
Company Name:
Site Contact. I
Lr
Mailing Address: +
State License #: KQR00 P;ot 0
Expiration Date
_... ..........
City Business License #:
PROPERTY INFORMATION:
Address:
rd
111 OW -3 I
Owner's Name.
Phone #:
Phone #:
Fax #: 2
425(-o- -....2 Z.. 11 _I_ «.7 . _.
Email #: ro bjM� l.�al►iiity
"BonLedCInsnrace�.M
❑ Full Line Replacement 'pot Repair ❑ Pipe Burst ❑ Reline (PermaLine Only)
DESCRIPTION OF PROPOSED WORK (Be Specific) :
SIGNATURE DATE'.
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE