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ENG2015-0360CONTRACTOR INFORMATION: Company Name: V:>d Company Address: City: Zip: State License # Y'sO q !z �f Expiration Date: PROPERTY INFORMATION: Address: / t?2z GCJ��U�S Owner's Name: -- Phone #: 2(f)b —r� SIDE SEWER FSA 0-J' AM Site Contact: j Phone #: �© Q0 , IR 1 b1(o$�- Email City Business License #' ❑ FULL LINE REPLACEMENT "POT REPAIR ❑ PIPE BURST DESCRIPTION OF PROPOSED WORK (Be Specific) : e a ❑ RELINE (PERMALINE ONLY) 7 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 PROPERTN I HAVE OWNERS EXPRES PERMISSION TO PERFORM WORK ON THAT ADJACENT PROPERTY. SIGNATURE DATE O 26 Contractor or Agent NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE City of Edmonds, WA City Clerk 121 5th Ave N Edmonds, WA 58020 (425) 775-2525 www,edmondswa.90v 003416-0004 Susan Q. 08/25/2015 11:56AM LICENSING BOB OATES SEWER ROOTER LLC 00048228 Non Resident Business License Application pendng 08/25/2015 50,00 2015 Item: 00048228 -------------- 50-00 50.00 Subtotal 50,00 Total 50.00 CREDIT CARD Visa Ref=150614348 Auth=035701 --------__----.- 0.00 Change due Paid by: ,IOHN AARON Signature. - --- ~ ----~_ Thank you for your payment. CUSTOMER COPY