ENG2022-0109+Supplementals+3.17.2022_12.54.51_PM+2744347r,
MyBui ldi ngPermi t. cem
Jurisdiction: Edmonds
Project Name: 7922 203rd St SW SFR Side Sewer
Application ID: 1099515
Supplemental Name: Authorization and Acknowledgment - Utilities
Please Note: A licensed and bonded contractor is required to perform sewer installation and repair.
Plumbing licenses will not be accepted for sewer work. Please contact WA State Labor & Industries for more information.
All provisions of laws and ordinances governing this type of work will be complied with. I certify under penalty of perjury that
the information provided on this application is true and correct and, further that I am authorized by the owner of the above
premises to perform the work for which the permit application is made. 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 my 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 authorized to file this application on behalf of the
owner of the subject property.
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/engineersiandsurveyors/docs/eDocsinterpretiveGuideline.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.
Kayla Nichols