ENG20170408-APPROVED PERMIT.pdfEDM NDS
CITY OF O
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20170408
i SIDF, SEWER PERMIT (]-Single Family)
Permit Number: ENG20170408 Expiration Date: 12/11 /2017
Job Address: 9722 CHERRY ST, EDMONDS
APPLICANT CONTRACTOR
ROT ROOTER SERVICES CO ROT ROOTER SERVICES CO
4630 16TH STREET E, SUITE B9 4630 16TH STREET E, SUITE 139
FIFE, WA 98424 FIFE, WA 98424
(253)568-7100
LICENSE #: ROTORSCI22BR EXP: 04/03/2018
N
N
JOR DESCRIPTION
REPAIR N PROPOSE TO REUSE LATERAL LID NUMBER:
GRINDER PUMP N PROPOSE TO REUSE SIDE SEWER N DRAINAGE
Install of c/o connect. ABS to PVC 4"pipe
LAS EMENT 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 ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or
any of its departments or employees, including but not limited to the defense of any legal proceedings including defense costs and
allorney 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 IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED,
Printed: Monday. October 09.2017
RELEASED BY
CW4z�U-)a lkod /0/9/20/7
DATE
❑ FILE COPY ❑ INSPECTOR COPY ❑ APPLICANT COPY
STATUS: ISSUED
ENG20170408
• 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 construction permit is required for workwithin 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 prior to obtaining approval for reuse. TVinspection required. Video
to be submitted to City for review.
• Easement and/or permission fi•omadjacent property owner isrequired prior toentry/work within 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 asbuiltatfinal inspection. See City Standards for requirements.
• Sound/Noise originating from temporary construction sites as a result of construction activity are exempt fromthe noise limits
ofECC 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 othertimes 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 from the 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.
INSPECTIONS
• E Sewer Asbuilt
• E Sanitary Side Sewer Inspection
PARTIAL INSPECTION DATE. INITIAL: NOTES:
PA RTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE:— ___ INITIAL:
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:
Site Contact:
Mailing Address: •-�r��`�
State License #: S C 2� Z
Expiration Date:
City Business License #:
PROPERTY INFORMATION:
Address:
Owner's Name:
Phone #:
❑ Full Line Replacement
Phone #: <) 3
Email #:
❑ Liability Insurance F1 Bonded
XSpot Repair ❑ Pipe Burst
DESCRIPTION OF PROPOSED WORK (Be Specific) :
❑ Reline (PermaLine Only)
SIGNATURE �� DATE
ontractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE