ENG-SEWER PERMIT.pdfof EVA4
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CONTRACTOR INFORMATION:
Company Name: D % `.
SIDE SEWER
PERMIT APPLICATION
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City: LLI 11Y►��.t�C�� t%1 (,(► A Zip: q Qd
State License # >>R 3b
Expiration Date: _ .?-0 Z
PROPERTY INFORMATION:
Site Contact:
Phone #: C, (o ty— LI I — I
Email #: �•+ �tv
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City Business License # Ne _ v Z (.0) y
Address: ` 0 9D 9 S ' D al /'
Owner's Name:
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Phone #:
❑ FULL LINE REPLACEMENT SPOT REPAIR ❑ PIPE BURST ❑ RELINE (PERMALINE ONLY)
DESCRIPTION OF PROPOSED WORK (Be Specific):
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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. .
SIGNATURE ftv DATE Z 2� 2[i 9
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
�.SEWER PERMIT
PERMIT NUMBER
City of •
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Description: Spot repair and add cleanout at house ISSUED: 12/23/2019
Address: 18408 91ST PL W EDMONDS WA 98026-5716
EXPIRES: 02/23/2020
Permit Type: SEWER Permit Subtype: PARTIAL LINE Parcel Number: 00434600004001
REPLACEMENT
CONTACTS
NAME TYPE NAME ADDRESS PHONE
OWNER FLYNN TODD D & CHRISTINA M 18408 91ST PL W, EDMONDS WA 98026-5716
FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE CHARGED PER PERMIT
$35.00 $0.00
SIDE SEWER PERMIT - PARTIAL REPLACEMENT $100.00 $0.00
REQUIREMENTS
REQUIREMENT TYPE NOTES
TRAFFIC CONTROL Traffic control and public safety shall be in accordance with City regulations as required by the
City Engineer. Every flagger must be trained as required by WAC 296-155-305 and must have
certification verifying completion of the required training in their posession.
RESTORATION Restoration is to be in accordance with City codes. All street -cut trench work shall be patched
with asphalt or City approved material prior to the end of the workday - No Exceptions
WARRANTY The contractor is responsible for workmanship and materials for a period of one year following
the final inspection and acceptance of the work.
INSPECTION SCHEDULING: WWW.MYBUILDING PERMIT.COM
24 HR NOTICE REQUIRED
INDEMNITY
The Applicant has signed an application which states he/she holds the City of Edmonds harmless from injuries, damages or claims of
any 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 attorney fees by reason of
granting this permit.
THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW
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