ENG2022-0069 SIDE SEWER PERMITSEWER PERMIT
PERMIT NUMBER
City of Edmonds
-0069
www.cityofedmonds.gov
Description: PAN - CONNECT ADDITION TO EX SIDE SEWER ISSUED: 02/23/2022
Address: 24025 79TH PL W EDMONDS WA 98026-9114
EXPIRES: 05/24/2022
Permit Type: SEWER Permit Subtype: PARTIAL LINE Parcel Number: 00511600000800
REPLACEMENT
CONTACTS
NAME TYPE NAME ADDRESS PHONE
APPLICANT MICHAEL SMITH PO BOX 2415, KIRKLAND WA 98083 (425)948-5356
CONTACT CHRYSALIS HOMES, LLC PO BOX 2415, KIRKLAND WA 98083 (425)948-5356
CONTRACTOR CHRYSALIS HOMES LLC PO BOX 2415, KIRKLAND WA 98083 (425)948-5356
OWNER JULY PAN 24025 79TH PL W, 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
•
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.
THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW
ENGINEERING DIVISION
"DTED
RELEASED BY
12/23/2022 DATE
Printed: Wednesday, February 23, 2022 10:21:45 AM 1 of 2
SEWER PERMIT
City of Edmonds
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.
Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to
indemnify defend and hold harmless the City of Edmonds, Washington, its officials, employees, and
agents from any and all claims for damages of whatever nature, arising directly or indirectly from the
HOLD HARMLESS
issuance for this permit. Issuance of this permit shall not be deemed to modify, waive or reduce any
requirements of any City ordinance nor limit in any way the City's ability to enforce any ordinance
provision.
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.
SEWER REQUIREMENTS
SEWER REQUIREMENTS
Sound/Noise originating from temporary construction sites as a result of construction activity are
exempt from the noise limits of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on
SOUND OR NOISE
weekdays and 10:00am and 6:00pm on Saturdays, excluding Sundays and Federal Holidays. At all
other times the noise originating from construction sites/activities must comply with the noise limits
of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
TRAFFIC CONTROL
TRAFFIC CONTROL
UNDERGROUND WIRING
All new, extended, rebuilt, or relocated electrical utility and/or service shall be placed underground.
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 SEWER PRESSURE
E-2 SIDE SEWER
Printed: Wednesday, February 23, 2022 10:21:45 AM 2 of 2
CITY OF EDMONDS M BuildingPermit.com
Utilities Application #1096819 - Edmonds Addition
Applicant
First Name Last Name Company Name
Michael Smith Chrysalis Homes, LLC
Number Street Apartment or Suite Number E-mail Address
PO Box 2415 1 keeper4me@gmail.com
City State Zip Phone Number Extension
Kirkland WA 98083 4259485356
Contractor
Company Name
CHRYSALIS HOMES LLC
Number Street Apartment or Suite Number
PO BOX 2415
City State Zip Phone Number Extension
KIRKLAND WA 98083 4259485356
State License Number License Expiration Date UBI # E-mail Address
CHRYSHL838J5 6/26/2023 ,;n:3F;nn7F;F; 1keeper4me@gmail.com
Project Location
Number Street Floor Number Suite or Room Number
24025 79TH PL W
City Zip Code County Parcel Number
EDMONDS 98026 00511600000800
Associated Building Permit Number Tenant Name
BLD2021-1146
Additional Information (i.e. equipment location or special instructions)_
Work Location
Property Owner
First Name Last Name or Company Name
July Pan
Number Street Apartment or Suite Number
24025 79TH PL W
City State Zip
EDMONDS WA 98026
Certification Statement - The applicant states:
I certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further certify that I have full power and
authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such application. I
have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of work
requires a licensed contractor to perform the work, the information will be provided prior to permit issuance.
Date Submitted: 2/22/2022 Submitted By: Michael Smith
Page 1 of 2
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CITY OF EDMONDS MyBuildingPermit.com
Utilities Application #1096819 - Edmonds Addition
Project Contact
Company Name: Chrysalis Homes, LLC
Name: Michael Smith Email: lkeeper4me@gmail.com
Address: PO Box 2415 Phone #: 4259485356
Kirkland WA 98083
Project Type
Single Family Residential
Activity Type Scope of Work
Utility Modification Side Sewer Repair Only
Project Name: Edmonds Addition
Description of Work: Install approximately 20 feet of side sewer from the addition and connect to the existing
side sewer from the main house (still on private property).
Project Details
Project Information
Relocate
Page 2 of 2