ENG20170258-APPROVED PERMIT.pdf�r
121 5TH A VENUE NORTH - EDMONDS, WA 98020
CITY OF ED�MONDS
PHONE: (425)'771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBS , *
STATUS: ISSUED ENG20170258
SIDE SEWER PERMIT
Permit Number: ENG20170258 Expiration Date: 07/07/2018
Job Address: 8710 184TH ST SWEDMONDS
APPLICANT CONTRACTOR
THE GORDON COMPANY INC
8710 184TH ST SW" 3781 GIBRALTER RD
EDMONDS, WA :98026-5721 ANACORTES, WA 98221
LICENSE #: GORDOCIO71 CH EXP: 10/19/2019
JOB DESCRIPTION
N IREPAIRPROPOSE TO REUSE LATERAL LID NUMBER:
N GRINDER PUMP N PROPOSE TO REUSE SIDE SEWER` N DRAINAGE'
I, LILL SIDE SEWER REPLA CEM ENT APPROXIMATELY48' WEST OF NORTHEAST PROPERTYCORNER. 6" REPLACEMENT IN
KOW , 4" REPLACEMENT ON PRIVATE PROPERTY
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EASEMENT INFORMATION
N PROJECT CROSSESOTHER PRIVATE PROPERTY
N F.'- t1FIC. TION 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 ofany 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
atlorney 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
APPLICATION APPROVAL
THIS APPLICATION ISNOT A PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER "DEPUTY. AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED TN
SPACE PROVIDED„
Printed: Frida JuI 07, 2017
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RELEASED BY DATE
FILE COPY ❑ INSPECTOR COPY ❑ APPLICANT COPY
FINAL INSPECTION APPROVED DATE: INITIAL:
SIDE SEWER,
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owner's Name:
Full Line Replacement El Spot Repair Ej Pipe Burst Reline (PermaLine Only)
DESCRIPTION OF PROPOSED WORK (Be Specific):
SIGNAT1,31-1 DATE QL
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NO AORK 9HALL BEGIN PRIOR TO PERMIT ISSUANCE