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CONTRACTOR INFORMATION:
SIDE SEWER
PERMIT APPLICATION
Company Name: Echelbarger Homes & Land, LLC Site Contact: Todd Echelbarger
Company Address: 4001 198th St. SW. #2
City: Lynnwood Zip: 98036
State License # Echeli1905M
Expiration Date: 3.28.2020
PROPERTY INFORMATION:
Address:
706 13th Way SW Edmonds, 98020
Owner's Name:
Echelbarger Homes & Land, LLC
Phone #: 425.673.1100
Email #: Todd@Echelbarger.com
City Business License # BL-010390
Phone #:
425.673.1100
® FULL LINE REPLACEMENT ❑ SPOT REPAIR ❑ PIPE BURST ❑ RELINE (PERMALINE ONLY)
DESCRIPTION OF PROPOSED WORK (Be Specific):
Connecting a new single family home to the existing side sewer stub on lot 5 of the Jenkins Lane plat.
ISSUANCE OF THIS PERMIT DOES NOT CONSTITUTE PERMISSION TO WORK ON ANY PROPERTY OTHER
THAN THAT OWNED BY THE SUBJECT PROPERTY OWNER.
CERTIFICATIONS NECESSARY FOR INSTALLATION METHODS ARE THE RESPONSIBILITY OF THE
CONTRACTOR PERFORMING SAID WORK.
I REPRESENT AND WARRANT TO THE CITY OF EDMONDS, IF REPAIR OF EXISTING SEWER EXTENDS TO AN
ADJACENT PROPERTY, I HAVE OWNERS EXPRESS PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY.
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SIGNATURE DATE � l
Contractor or Agent
RECEIVED
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE OCT 17 2019
BUILDING