BLD2021-1450_Side_Sewer_Application_12.8.2021_10.21.54_PM_2561869RESUB
SIDE SEWER
PERMIT APPLICATION
Dec 09 2021
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
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CONTRACTOR INFORMATION:
Company Name: Home Pro R & C Inc. site Contact: Daniel Elmaliach
Company Address: PMB 1611, 300 Lenora St Phone #: 1-954-496-2033
PMB 1611, 300 Lenora St
City: Seattle WA zip: 98121 Email #: Daniel.elmaliach@gmail.com
State License # HOMEPRC792J9 City Business License #
Expiration Date: 04/30/2023 Pending confirmation no: 0-023-528-410
PROPERTY INFORMATION:
Address: 19729 81 st PI W
Owner's Name:
Kenshu Aoki
Phone #:
DULL LINE REPLACEMENT SPOT REPAIR [:]PIPE BURST RELINE (PERMALINE ONLY)
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DESCRIPTION OF PROPOSED WORK (Be Specific): MOVE CLEAN OUT SOUTH 4' FROM UNDER PROPOSED ADDITION. REDO
4" SS AS NEEDED AT NEW FOOTING
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ISSUANCE OF TIIIS PERMIT DOES NOT CONSTITUTE PERMISSION TO WORK ON ANY PROPERTY OTHER
THAN THAT OWNED I3Y 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.
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SIGNATURE 20212.03104s°' )- DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE