Engineering Permit FormSEWER NEW RESIDENTIAL PERMIT
PERMIT NUMBER
City of Edmonds
Ave N, Edmonds WA ••• • ENG2021-0530
www.cityofedmonds.gov• •
Description: NEW SEWER FOR NEW SFR 131 SKYLINE ISSUED: 01/27/2022
Address: 131 SKYLINE DR EDMONDS WA 98020
EXPIRES: 07/26/2022
rmit Type: SEWER NEW RESIDENTIAL Permit Subtype: Parcel Number: 00423000005300
•
i
NAME TYPE NAME ADDRESS PHONE
APPLICANT JOHN RIENTJES 13518 120TH AVE NE, KIRKLAND WA 98034 (425)864-3049
CONTACT JOHN RIENTJES 13518 120TH AVE NE, KIRKLAND WA 98034 (425)864-3049
CONTRACTOR D L SIGLER CONSTRUCTION 2607 244TH AVE NE, SAMMAMISH WA 98074- (425)522-4762
OWNER SUE EASTMAN\GERALD E KING 8433 SE 62ND ST, MERCER ISLAND WA 98040
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
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
DATE
Printed: Thursday, January 27, 2022 1:30:26 PM 1 of 2
A SEWER NEW RESIDENTIAL PERMIT
PERMIT NUMBER
j City of Edmonds
121 5th Ave N, Edmonds WA 98020 ENG2021-0530
-- =- www.cityofedmonds.gov / 425.771.0220
CONDITIONS
INSPECTIONS
DATE
®�
COMPLETEE-2
SIDE SEWER
X-2 ENGINEERING FINAL"
E-7 SEWER LATERAL
Printed: Thursday, January 27, 2022 1:30:26 PM 2 of 2