Engineering Permit Form (2)NEW RESIDENTIAL PERMIT
PERMIT NUMBER
City of Edmonds
EdmondsSEWER
98020ENG2021-0161
hL
www.cityofedmonds.gov
Description: SELECT LOT 2 - SIDE SEWER CONNECT TO SHORT PLAT STUB ISSUED: 09/28/2021
Address: 1006 WALNUT ST EDMONDS WA 98020-3336
EXPIRES: 09/23/2022
rmit Type: SEWER NEW RESIDENTIAL Permit Subtype: Parcel Number: 27032500100500
• '
i
NAME TYPE NAME ADDRESS PHONE
APPLICANT SELECT HOMES INC 8304 212th ST SW, Edmonds WA 98026
CONTRACTOR SELECT HOMES INC 8304 212th ST SW, Edmonds WA 98026
OWNER KEEGAN EVA MARIE 1012 WALNUT ST, EDMONDS WA 98020 (425)446-2631
FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE CHARGED PER PERMIT
$40.00 $40.00
ENGINEERING INSPECTION FEE
$110.00 $110.00
SEWER GENERAL FACILITY CHARGE - NEW SFR
$4,417.00 $4,417.00
SIDE SEWER PERMIT - NEW RESIDENTIAL
$110.00 $110.00
•
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.
RELEASED BY
THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW
DATE
Printed: Tuesday, September 28, 2021 3:24:11 PM 1 of 2
I j
SEWIMEW RESIDENTIAL PERMIT
U-
City of • • •
•:• •ENG2021-0161
. -. ov/425.771.0220
CONDITIONS
CONDITION TYPE
All utilities shall be located prior to any excavation. New locates shall be called for if at time of
UTILITY LOCATES
excavation, original locates are no longer identifiable.
WATER AND SEWER
Maintain 10' of separation between the sanitary side sewer and the water service line.
SEPARATION
INSPECTIONS
INSPECTION TYPE
DATE
RESULT
COMPLETE
X-2 ENGINEERING FINAL"
E-2 SIDE SEWER
Printed: Tuesday, September 28, 2021 3:24:11 PM 2 of 2