ENG20170398-APPROVED PERMIT.pdfCITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20170398
SIDE SEWER PERMIT (I -Single Fan-dly)
Permit Number: ENG20170398 Expiration Date: 12/06/2017
Job Address: 7405 172ND ST SW, EDMONDS
APPLICANT CONTRACTOR
ROT ROOTER ROTO ROOTER
10655 TUKWILLA INTERNATIONAL BLVD 10655 TUKWILLA INTERNATIONAL BLVD
TUKWILLA, WA 98160 TUKWILLA, WA 98160
(206)255-2661
LICENSE #: ROT ORSCI22BR EXP: 04/03/2018
Y
N
1: DESCRIPTION
REPAIR N J PROPOSE TO REUSE LATERAL LID NUMBER:
I GRINDER PUMP N I PROPOSE TO REUSE SIDE SEWER F N 1 DRAINAGE
Small spot repair in middle of yard.
LASFVIENTINFORMATION
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 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
APPROVALAPPLICATION
THIS APPLICATION IS NOTA PERWTUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Friday, October 06, 2017
C' � U)ayAa 101(o/Z017
RELEA SED BY
DATE
❑ FILE COPY ❑ INSPECTOR COPY ❑ APPLICANT COPY
STATUS: ISSUED
ENG20170398
• 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 constriction permit is required forworkwithin 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 of the existing sanitary side sewer to 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/workwithin 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 fromtemporary construction sites as a result of construction activity are exempt fi•omthe noise limits
ofECC 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 from 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.
• E-Sanitary Side Sewer Inspection
PARTIAL INSPECTION
PARTIAL INSPECTION
FINAL INSPECTION APPROVED
DATE:
INSPECTIONS
INITIAL:
DATE: INITIAL:
DATE: INITIAL:
NOTES:
NOTES:
If your project is SOUTH of 220th St.
and/or WEST of Hwy 99, it may be in
Olympic View Water & Sewer District
SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: pol" � jk-r
Site Contact: �r 1 S Phone #: 4,
Iz-7
Mailing Address:/(,6SST �-j,,IC
State License #: R0j-C) g5 c/z z 9t;
Expiration Date: i/`S / /S8
City Business License #: P9_ 0 ZZ S 11
PROPERTY INFORMATION:
Address: %VU-5 l7z ,zi- S4- -'�ej
Owner's Name:
Phone #:
Fax #:
Email #:
❑ Liability Insurance D Bonded
❑ Full Line Replacement pot Repair El Pipe Burst ❑ Reline (PermaLine Only)
DESCRIPTION OF PROPOSED WORK (Be Specific) :
'S sey 4- ('_ip! ' 1;' i Vl Y4-7 / CMG k C), ' ✓0 'r
SIGNATURE �C DATE
Contractor or gent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE