ENG2022-0234 SEWER PERMITPERMIT
PERMIT NUMBER
City of Edmonds
EdmondsSEWER
98020 1 1 �
www.cityofedmonds.gov
Description: SPOT REPAIR ON PRIVATE PROPERTY ISSUED: 05/19/2022
Address: 555 HOMELAND DR EDMONDS WA 98020-4026
EXPIRES: 08/17/2022
Permit Subtype: PARTIAL LINE
Permit Type: SEWER Parcel Number: 00477300001200
REPLACEMENT
CONTACTS
NAME TYPE NAME ADDRESS PHONE
APPLICANT CHIP MONTAGUE 2825 S 154TH ST, SEATTLE WA 98188 (253)508-0460
CONTACT PRICOR TECHONOLOGIES 2825 S 154TH ST, SEATTLE WA 98188 (253)508-0460
CONTRACTOR PRICOR TECHNOLOGIES LLC 2825 SOUTH 154TH STREET, SEATTLE WA 98188 (206)258-5270
OWNER DOROTHY L LINDSTROM 555 HOMELAND DR, EDMONDS WA 98020-4026
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
05/19/2022
G»RAF9:1•i ]1
DATE
Printed: Thursday, May 19, 2022 10:56:04 AM 1 of 2
SEWER PERMIT
City of Edmonds
•:• •ENG2022-023
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.
SEWER AND WATER
MAINTAIN 10 FEET OF SEPARATION BETWEEN THE SANITARY SIDE SEWER AND THE WATER SERVICE
SEPARATION
LINE.
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.
TRAFFIC CONTROLS
Traffic Control per approved plan and MUTCD. All Flaggers shall be certified.
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.
PECTION TYPE DATE RESULT NOTES
2r lip
7SIDE
COMPLETE
R
X-2 ENGINEERING FINAL"
Printed: Thursday, May 19, 2022 10:56:04 AM 2 of 2
4.FU',6
CONTRACTOR INFORMATION:
Company Name:
Company Address:
SIDE SEWER
PERMIT APPLICATION
Site Contact: A I
LAt
.5%1,6 44 Phone #: &,:.7 '" a�J
City: 5mflf, . Zip: g4;616
State License # ?vWa\ay 4
Expiration Date:
PROPERTY" INFORMATION:
Address: 5
Owner's Name:
Phone #:
❑ FULL LINE REPLACEMENT X SPOT REPAIR
DESCRIPTION OF PROPOSED WORK (Be Specific):
Email #:
City Business License # A Q Rolsbzis
❑ PIPE BURST ❑ RELINE (PERMALINE ONLY)
ISSUANCE 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 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 HA OWNERS EXPRESS PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY.
Y
SIGNATURE DATE
Contr ctor or Xgent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
RECEIVED
CITY OF EDMONDS
Utilities Application #1144990 - 555 Homeland Dr
May 18 2022
MyBuildingPermit.com CITYOFEDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
Applicant
First Name Last Name Company Name
Chip Montague PriCor Techonologies
Number Street Apartment or Suite Number E-mail Address
2825 S 154th St cmontague@pricortech.com
City State Zip Phone Number Extension
Seattle WA 98188 (253)508-0460
Contractor
Company Name
PRICOR TECHNOLOGIES LLC
Number Street Apartment or Suite Number
2825 SOUTH 154TH STREET
City State Zip Phone Number Extension
SEATTLE WA 98188 (206)258-5270
State License Number License Expiration Date UBI # E-mail Address
PRICOTL865KZ 5/14/2024 FDiiAF;sis cmontague@pricortech.com
Project Location
Number Street Floor Number Suite or Room Number
555 HOMELAND DR
City Zip Code County Parcel Number
EDMONDS 98020 00477300001200
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
Dorothy L Lindstrom
Number Street Apartment or Suite Number
555 HOMELAND DR
City State Zip
EDMONDS WA 98020-4026
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: 5/18/2022 Submitted By: Chip Montague
Page 1 of 2
i
CITY OF EDMONDS MyBuildingPermit.com
Utilities Application #1144990 - 555 Homeland Dr
Project Contact
Company Name: PriCor Techonologies
Name: Chip Montague Email: cmontague@pricortech.com
Address: 2825 S 154th St Phone #: (253)508-0460
Seattle WA 98188
Project Type Activity Type Scope of Work
Single Family Residential Utility Modification Partial Line Replacement
Project Name: 555 Homeland Dr
Description of Work: spot repair on the side sewer on private property
Project Details
Project Information
Repair
Page 2 of 2
r /
MyBuildingPermitxom
Jurisdiction: Edmonds
Project Name: 555 Homeland Dr
Application ID: 1144990
Supplemental Name: Authorization and Acknowledgment - Utilities
Please Note: If the work is not being performed by a homeowner, a licensed and bonded General Contractor or
Plumbing Contractor is required to perform sewer installation and repair.
An individually Licensed Plumber license will not be accepted for sewer work. Please contact WA State Labor & Industries for more
information.
Yes, I acknowledge
All provisions of laws and ordinances governing this type of work will be complied with. I further agree to hold harmless the City
of Edmonds as to any claim (including costs, expenses, and attorney's fees incurred in investigation and defense of such claim),
which may be made by any person, including the undersigned, and filed against the City of Edmonds, but only where such claim
arises out of the reliance of the City, including its officers and employees, upon the accuracy of the information supplied to the
City as part of this application.
I hereby authorize the City representatives to inspect the property Monday -Friday between the hours of 8:00 a.m. and 5:00 p.m.
during this permit application process for verifying site conditions.
I certify, under the penalty of perjury under the laws of the State of Washington, that the information and exhibits herewith
submitted are true and correct to the best of my knowledge and that I am the owner or am authorized by the owner of the
subject property to file this application on their behalf.
Yes, I authorize.
Electronic documents submitted to the City of Edmonds for plan review and permit issuance must be provided in a format that
does not prevent the City from making code comments on the documents during review or from making the documents ready for
permit issuance. Documents submitted in any manner that prevents the City from completing the review and permit issuance
process, including but not limited to submitting documents that are locked, may result in additional review time, permitting
delays, and/or cancellation of the permit application if the problem is not resolved by the applicant in a timely manner.
Please refer to chapter 18.43 RCW, chapter 18.210 RCW, chapter 1 96-23 WAC and chapter 1 96-33 WAC for Washington State
laws governing electronic documents. An interpretative guideline from the Board of Registration for Professional Engineers and
Land Surveyors can be found at http://www.dol.wa.gov/business/engineerslandsurveyors/docs/eDocslnterpretiveGuideline.pdf.
These laws and requirements are subject to change and the submitting parties are responsible for keeping apprised of any such
changes.
Please acknowledge that you understand these requirements and have verified the electronic documents being submitted meet
the City of Edmonds submittal requirements by checking the box below. If you have questions, contact the Engineering
Division at engineeringpermits@edmondswa.gov or 425-771 -0220.
Yes, I acknowledge.
The City of Edmonds makes permit applications available to the public in an effort to make its processes as transparent as
possible. By signing or initialing this document, I acknowledge that any and all information submitted as part of this application,
is public information. I further acknowledge and agree that this permit application, and any and all documents related
thereto, may be disclosed by the City of Edmonds to the public without redaction.
Please sign below to acknowledge.
Chip Montgaue