BLD2020-0679+SS APPLIC+1.27.2021_2.54.11_PM+2014162of EVA-10
4 � a•
SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name:
ompany Address: I �J
IeW �� to
fifty: Zip:
State License # e e:
xpiration Date: ,
PROPERTY INFORMATION:
Xddress: 18711 8$th Avenue West, Edmonds, WA
ez Contact:
Phonet: Q, Q
Email #:
City Business License #
Owner's Name. � y el!; t1 e�i 7*A e �C
hone #: (206) 715-2400
FULL LINE REPLACEMENT ❑ SPOT REPAIR ❑ PIPE BURST ❑ RELINE (PERMALINE ONLY)
DESCRIPTION OF PROPOSED WORK (Be Specific):
New side sewer connection for new single-family residence.
SSUANCE 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 METIIODS ARE THE RESPONSIBILITY OF THE
CONTRACTOR PERFORMING SAID WORK.
Q REPRESENT AND WARRANT TO THE CITY EDMONDS, IF REPAIR OF EXISTING SEWER EXTENDS TO AN
ADJACENT PROPERTY, I HAVE OWNERS PRESS PERMISSION TO PERFORM WORK ON THAT ADJACENT
ftOPERTY.
;IGNATU DATE I- 7
ontractor or t
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE