ENG2021-0429 APPROVED SEWER PERMITSEWER PERMIT
PERMIT NUMBER
City of Edmonds
...0iENG2021-0429
www.cityofedmonds.gov
Description: SEWER FRIENDLY CLEANOUT INSTALL ISSUED: 11/09/2021
Address: 7713 191ST ST SW EDMONDS WA 98026-6033
EXPIRES: 02/07/2022
Permit Subtype: PARTIAL LINE
Permit Type: SEWER Parcel Number: 00418000001000
REPLACEMENT
CONTACTS
NAME TYPE NAME ADDRESS PHONE
APPLICANT SEWER FRIENDLY 23930 HIGHWAY 99, EDMONDS WA 98026 (206)931-8161
CONTRACTOR SEWER FRIENDLY 23930 HIGHWAY 99, EDMONDS WA 98026 (206)931-8161
OWNER TIMM ALICE A 7713 191ST ST SW, EDMONDS WA 98026
FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $40.00
SIDE SEWER PERMIT - PARTIAL REPLACEMENT $110.00 $110.00
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.
RELEASED BY
THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW
11 /9/2021
DATE
Printed: Tuesday, November 09, 2021 1:06:15 PM 1 of 2
SEWER PERMIT
PERMIT NUMBER
City of Edmonds
..• • 1 14•
www.cityofedmonds.gov• •
CONDITIONS
CONDITION TYPE
It is the owner's responsibility to repair/replace all damage of utilities or frontage improvements in
DAMAGE TO FRONTAGE
City right of Ways or Easements to City Standards caused by or occurring during the permitted
IMPROVEMENTS
project.
ESC REQ
Maintain erosion and sedimentation control per City and SWMMW standard requirements.
INSP PRIOR TO BACKFILL
Call for all required inspections. All work shall be inspected prior to backfill.
Owner/Contractor to provide Side Sewer asbuilt at final inspection. See City Handout E71 for
SEWER ASBUILT
requirements.
PLEASE REFER TO STANDARD DETAILS SS-200, SS-201 AND, SS-202. STANDARD DETAILS CAN BE
FOUND ON THE CITY OF EDMONDS WEBSITE. SDR35 WITH GASKETED FITTINGS IS REQUIRED FOR ALL
SEWER REPAIRS. FOR ANY REPAIRS WHERE THERE IS MORE THAN ONE STICK OF PIPE, A PRESSURE
SEWER REQUIREMENTS
TEST IS REQUIRED. WHERE LINING OR PIPE BURSTING WATER AND TV TEST IS REQUIRED. IF THE 4-6
TRANSITION IS ENCOUNTERED, A 6" CLEANOUT IS REQUIRED AT THE PROPERTY LINE. THE 6"
CLEANOUT SHALL HAVE A 12" CAST IRON LAMPHOLE COVER WITH 1/2 HEX BOLTS, GRIPPER TWIST
PLUG, AND A 24" CONCRETE COLLAR. AN AS BUILT IS REQUIRED PRIOR TO FINAL OF THE PERMIT.
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.
PECTION TYPE DATE RESULT NOTES
7SIDE
COMPLETE
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Printed: Tuesday, November 09, 2021 1:06:15 PM 2 of 2
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SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: , ,1"ff V- f`M/�,�,/� 1 9 G Site Contact: �tl ` Olt.
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Company Address: ' 1 � 9V 1 L�l� Phone #:
City: lecw C, Zip:
State License # �Q`"%CJ Q O
Expiration Date: v
PROPERTY INFORMATION:
Address:
Owner's Name: W
Phone #:
Email #: i4o 61 Seitlle W%epAdIy, Cayv%
City Business License # (L ►_ _ O' 001
❑ 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 DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE