ENG20170190-APPROVED PERMIT.pdfCITY OF EDMONDS
121 5TH AVENUENORTH - EDMONDS, WA 98020
1 rtle PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOB51TE*
STATUS: ISSUED ENG20170190
SIDE SEWER PERMIT (]-Single Fainiky)
Permit Number: ENG20170190 Expiration Date: 07/18/2017
Job Address: 9307 231 ST ST SW, EDMONDS
[APPLICANT CONTRACTOR —
THE DRAIN DOCTORS THE DRAIN DOCTORS
13300 BOTHELL-EVERETT HWY #621 13300 BOTHELL-EVERETT HWY 4621'
BOTHELL, WA 98012 BOTHELL, WA 98012
(425)'337-0735
LICENSE #: DRAINDD912MH . _EXP: 07/08/2017
JOB DESCRIPTION
Y iREPAIR N PROPO FTOREUSELATERAL LID NUMBER:
N' GRINDER PUMP N FROPOE TO REUSE SIDE SEWER N DRAINAGE
SEWER SPOT REPAIR. -
INFORMATION
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 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
atlorneyfees by reason'ofgranting this permit.
CALL DIA1,A-DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
APPLICATION A1113ROVAL
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' Thurs da M Iif 201'
RELEA SED BY DATE
�FILE COPY F-1 INSPECTOR COPY ❑ APPLICANT COPY
pf Ca""0
C. � o
CONTRAcrOR INFORMATION:
Company Name: —
11)eSite Contact: 1��� �.r, 17 ocAv�-5
Phone #: �
1�ow.\1 e v�nr.v,�
Mailing Address:
State License #: D Y2A i N iz mo 2,V,
Expiration Date: -1
City Business License #:'N i2 - crz31415
Zo `d�Pl 2$'13
Fax #: N A
F--ov�,eII X1301'7-
Email
13012
Email #: � � � � '� e._C, Ya � 'v�_cl o ci-�sy5 . ►'� 2.-1t-
Liability Insurance Bonded
Address: rYl nn cis 1r.\ A
Owner's Name:
�v 1
Phone#: (,o3
❑ Full Line Replacement Spot Repair ❑ Pipe Burst ❑ Reline (PermaLine Only)
DESCRIPTION OF PROPOSED WORK (Be Specific) :
dew .� — t l` ...........
SIGNATURE DATE
4ontt�/actor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE