ENG20170406-APPROVED PERMIT.pdf�y v CITY OF EDMONDS
121 5TH AVENUE NORTH -EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSTTE*
STATUS: ISSUED ENG20170406
SIDE SEWER PERMIT (I -Single Family)
Permit Number: ENG20170406 Expiration Date: 12/11 /20l 7
Job Address: 9025 218TH ST SW, EDMONDS
JAMES FOTI
9025 218TH ST SW
EDMONDS, WA 98026-7864
JAMES FOTI
9025 218TH ST SW
EDMONDS, WA 98026-7864
(503)887-2093
LICENSE 4 EXP.
Y
N
.JOB DESCRIPTION
REPAIR N PROPOSE TO REUSE LATERAL LIDNUMBER:
GRINDER PUMP N I PROPOSE TO REUSE SIDE SEWER F N 1 DRAINAGE
Side sewer reline, located 2" from house on E side, 40' to street.
FASEMENTINFORMATION
N PROJECT CROSSES OTHER PRIVATE PROPERTY
N VERIFICATION OF RECORDED EASEMENTS COMPLETE
DVDEMATTY The Applicant has signed an application which stales 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
attorney fees by reason ofgranling 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
THIS APPLICATION IS NOT PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
RELEA SED BY
Printed: Monday. October 09, 201
DATE
❑ FILE COPY ❑ INSPECTOR COPY APPLICANT COPY
STATUS: ISSUED
ENG20170406
• Refer to City of P,dmonds Side Sewer Infornuiuion 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-ot=way construction permit is required for work within the City right-of-way.
• Condition ofthe existing lateral to be verified by the City's Public Works Dept. to obtain approval for reuse. Contact Edmonds
Sewer Division at425-771-0235.
• 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'workwithin adjacent property.
• Applicant shall repair/replace all damage to utilities or frontage i nprovements 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 from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 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 FCC 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-SEWERASBUILT
• E-TV AND WATER TEST
• E-Sanitary Side Sewer Inspection
PARTIAL INSPECTION
PARTIAL INSPECTION
FINAL INSPECTION APPROVED
]INSPECTIONS
DATE: INITIAL: NOTES:
DATE: INITIAL:_____ NOTES:
DATE: INITIAL:___
SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name:
Site Contact:
Mailing Address:
State License #:
Expiration Date:
F-e- .1" C-//
Phone #:
702 f 7 Af
City Business License #:
Fax #:
c�—OP;7 201 )'
Email #:
❑ Liability Insurance ❑ Bonded
PROPERTY INFORMATION: r
Address: ��% 2 S 2� b
Owner's Name:
Phone #:
❑ Full Line Replacement ❑ Spot Repair ❑ Pipe Burst P5NReline (PermaLine Only)
DESCRIPTION OF PROPOSED WORK (Be Specific) :
SIGNATURE i�� 'i DATE �G _
,Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE