Issued permit.pdfy OF GUMU
"N CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
�PHONE: (425) 771-0220 - FAX: (425) 771-0221
1%
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20180544
SIDE SEWER PERMIT (]-Single Family)
Permit Number: ENG20180544 Expiration Date: l 2/28/2018
Job Address: 9331 218TH PL SW, EDMONDS
APPLICANT CONTRACTOR
Camerons One LLC, dba NW Sewer & Drain Camerons One LLC, dba NW Sewer & Drain
PO Box 55573 PO Box 55573
Shoreline, WA 98135
Shoreline, WA 98135
(206)931-7728
LICENSE #: NWSEWSD863PB EXP:
Y
N
JOB DESCRIPTION
PROPOSE TO REUSE LATERAL LID NUMBER:
REPAIR HN
GRINDER PUMP PROPOSE TO REUSE SIDE SEWER EN I DRAINAGE
Complete a spot repair and install CIPP liner.
EASEMENT1' 1
-_LLJ
PROJECT CROSSES OTHER PRIVATE PROPERTY
N
IVERIFICATION OF RECORDED EASEMENTS COMPLETE
INDEMNITY- The Applicant has signed an application which states he/she holds the City ofEdmonds harmless from injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City ofEdmonds 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 DIALrA-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 1S NOT PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
i
RELEA
TE
Thursday, November 29, 201
❑ FILE COPY 7 INSPECTOR COPY ❑ APPLICANT COPY
STATUS: ISSUED
ENG20180544
• 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 work within 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 ofthe exdsting sanitary side sewer to be verified prior to obtaining approval for reuse. TV inspection required. Video
to be submitted to City for review.
• Easement and/or permission fi•om adjacent property owner is required prior to entry/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 asbuilt at final inspection. See City Standards for requirements.
• Sound/Noise originating from temporary construction sites as a result of construction activity are exempt fi•omthe noise limits
ofECCChapter 5.30 only during the hours of7:00amto 6:00pmon weekdays and 10:00amand 6:00pmon Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originating fi•om 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 fi•om any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance ofthis permit. Issuance of this 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-TV water test
• E Sanitary Side Sewer Inspection
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
SIDE SEWER
PERMT APPLICATION
CONTRACTOR INFORMATION:
Company Name: ()Ile L �C_ Jbe- /; _0 (3 UU/l r ILI
Site Contact: , c Phone #: J
Mailing Address. Q L) ,k Jam_ J. ' `511,119 VI► Fax #:
State License #: � �'V�c y�% �� ��;
Expiration Date: �T� ► is 11"� Email rl V'v �:.'�' y�. (. i 1t�%l
City BusinessLicense EfLiability Insurance & Bonded
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PROPERTY INFORMATION:
Address: 9 3 3, — Z l O-l' P L 5\
Owner's Name:
V 1, ci lilknt
Phone#: "2S— -7_7/—Lf1L/C5
❑ Full Line Replacement [Spot Repair
❑ Pipe Burst
DESCRIPTION OF PROPOSED WORK (Be Specific) :
(Reline (PermaLine Only)
r%i
SIGNATURE V, DATE 2—ql M
ontractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERAHT ISSUANCE