ENG2022-0153 SEWER PERMITPERMIT
PERMIT NUMBER
City of Edmonds
EdmondsSEWER
98020 1 1
www.cityofedmonds.gov
Description: SPOT REPAIR AT THE 4" TO 6" TRANSITION ISSUED: 04/11/2022
Address: 7903 242ND ST SW EDMONDS WA 98026-9124
EXPIRES: 07/10/2022
Permit Type: SEWER Permit Subtype: PARTIAL LINE Parcel Number: 00488700100802
REPLACEMENT
CONTACTS
NAME TYPE NAME ADDRESS PHONE
APPLICANT DONALD JACKSON 7306 210TH ST SW, EDMONDS WA 98026 (425)877-5601
CONTACT DONALD JACKSON 7306 210TH ST SW, EDMONDS WA 98026 (425)877-5601
CONTRACTOR ACTION JACKSON DRN CLN/PLB LLC 7306 210TH ST SW, EDMONDS WA 98026 (425)877-5601
OWNER ANNE C & SAMS EDMUND TERRY 7903 242ND ST SW, EDMONDS WA 98026
FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $40.00
ENGINEERING INSPECTION FEE $110.00 $110.00
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.
VAIA-344.7 YA
THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW
04/11 /2022
DATE
Printed: Monday, April 11, 2022 3:43:37 PM 1 of 2
SEWER PERMIT
City of • • •
•:• •ENG2022-01531
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.
MAINTAIN EROSION AND SEDIMENTATION CONTROL PER CITY AND SWMMW STANDARD
ESC REQUIREMENTS
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.
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.
Sound or 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 AND 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 and activities must comply with the noise
limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
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.
'SIDE
•
INSPECTION TYPE
DATE
RESULT
NOTES
COMPLETE
E-2 SEWER
X-2 ENGINEERING FINAL"
E-7 SEWER LATERAL
Printed: Monday, April 11, 2022 3:43:37 PM 2 of 2
CITY OF EDMONDS M BuildingPermit.com
Utilities Application #1122607 - Sewer repair
Applicant
First Name Last Name Company Name
Donald Jackson ACTION JACKSON DRN CLN/PLB LLC
Number Street Apartment or Suite Number E-mail Address
7306 210th st sw actionjacksondcap@yahoo.com
City State Zip Phone Number Extension
Edmonds WA 98026 (425)877-5601
Contractor
Company Name
ACTION JACKSON DRN CLN/PLB LLC
Number Street Apartment or Suite Number
7306 210th st sw
City State Zip Phone Number Extension
EDMONDS WA 98026 (425)877-5601
State License Number License Expiration Date UBI # E-mail Address
ACTIOJD884M7 8/3/2022 F;nign1 BDD actionjacksondcap@yahoo.com
Project Location
Number Street Floor Number Suite or Room Number
7903 242ND ST SW
City Zip Code County Parcel Number
EDMONDS 98026 00488700100802
Associated Building Permit Number Tenant Name
Additional Information (i.e. equipment location or special instructions)_
Work Location
Property Owner
First Name Last Name or Company Name
Anne C & Sams Edmund A Terry
Number Street Apartment or Suite Number
7903 242ND ST SW
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: 4/11/2022 Submitted By: Donald Jackson
Page 1 of 2
i
CITY OF EDMONDS MyBuildingPermit.com
Utilities Application #1122607 - Sewer repair
Project Contact
Company Name:
Name:
Address:
Donald Jackson
7306 210th st sw
Edmonds Wa 98026
Project Type
Single Family Residential
Email: Actionjacksondcap@yahoo.com
Phone #: 4258775601
Activity Type Scope of Work
Utility Modification Partial Line Replacement
Project Name: Sewer repair
Description of Excavate up to 5 feet at marked location of break found with sewer camera. Locate and cut
Work: out broken section of pipe at the 4inch to 6 inch transition. Replaced with pvc, bed pipe, test
for leaks, have inspection, return native dirt to hole.
Project Details
Project Information
Repair
Page 2 of 2