ENG20170225-SIDE SEWER.pdfCITY OF EDMONDS
121 5TH AVENUENORTH-'EDMONDS, WA 98020'
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBS T *
STATUS: ISSUED ENG20170225
SIDE SEWER PERMIT (I -Single Family)
Permit Number: ENG20170225 Expiration Date: 06/09/2018
Job Address: 396 SUNSET AVE N,EDMONDS
APPLICANT CONTRACTOR 116
PACIFIC EMERALD HOMES INC
PO BOX 9 PO BOX 822
EDMONDS, WA 98020 EDMONDS, WA 98026
LICENSE #: PACIFEH090KZ EXP. 08/23/2018
JOB DESCRIPTION
Y REPAIR Y PROPOSE TO REUSE LATERAL LID NUMBER:
N GRINDER N PROPOSE TO REUSE SIDE SEWER N DRAINAGE
Side Sewer Connection at north corner of property
EASEMENT
_
N PROJECT CROSSES OTHER PRIVATE PROPERTY
N ERIIm l(„ATION OF RECORDED EASEMENTS COMPLETE
No public easements,
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 made against the City of Edmonds or
any ofits departments or employees, including but not limited to the defense ofanylegal 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 INSPECTION REQUESTS
XPPLICATION APPROVAL
THIS APPLICATION IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HISMERDEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED
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FILE COPY F1 INSPECTOR COPY APPLICANT COPY
Company Name:
SIDE SEWER
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Conta_c_t_:_
Mailing Address:,
--State -License #:
Expiration P!!e: � � �'1
City Business License
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PROPERTY INFORMATI
Address.
Owner's Name:
Phone #:
Phone#: c_-,_
Fax #:
#
Email -
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_gEiability Insurance ---Bond 'd
Full Line Replacement [] Spot Repair F-1 Pipe Burst
DESCRIPTION OF PROPOSED WORK (Be Specific):
SIGNATURE
a
or Agent
E] Reline (PerinaLine Only)
DATE
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE