Side_Sewer_Application-11-2012.pdf
SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name:
Sound Mind Construction
Site Contact: Phone #:
Brian Lettman206.310.7048
Mailing Address: Fax #:
206.838.5635
State License #:
SOUNDMC887RD
Email #:
BrianL@soundmind.me
Expiration Date:
12/4/2016
City Business License #: Liability Insurance Bonded
NR-021522 X X
PROPERTY INFORMATION:
Address:
9813 215th St SW Edmonds, WA
O
Jan Flowers & Mace Burke
Phone #:
206.334.5263
x
Full Line Replacement Spot Repair Pipe Burst Reline
(PermaLine Only)
DESCRIPTION OF PROPOSED WORK (Be Specific) :
Repair / Replace a section of the existing sewer line on the property
SIGNATURE DATE
4/29/2015
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE