Engineering Permit Form ENG2022-0446SEWER PERMIT
PERMIT NUMBER
City of Edmonds
ww.cityofedmonds.gov
Description: SEWER - INSTALL A CLEAN OUT ON THE OUTSIDE OF NEW ADDITION
ISSUED: 09/07/2022
Address: 19637 80TH PL W EDMONDS WA 98026-6404
EXPIRES: 09/07/2023
Permit Subtype: PARTIAL LINE
Permit Type: SEWER Parcel Number: 00506400000900
REPLACEMENT
CONTACTS
NAME TYPE NAME ADDRESS PHONE
APPLICANT TUVIA POLISKIN 19219 51ST AVE NE, LAKE FOREST PARK WA 98155-2940 (425)395-4861
CONTACT T2 DESIGN 19219 51ST AVE NE, LAKE FOREST PARK WA 98155-2940 (425)395-4861
CONTRACTOR BUILT BY DESIGN WA INC 2114 120TH PL SW, EVERETT WA 98208 (425)327-4529
OWNER JOHN WESLEY & SARA LANG 19637 80TH PL W, EDMONDS WA 98026-6404
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.
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RELEASED BY
THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW
9/7/2022
DATE
Printed: Wednesday, September 07, 2022 3:49:15 PM 1 of 2
SEWER PERMIT
PERMIT NUMBER
City of Edmonds
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CONDITIONS
CONDITION TYPE
NOTE116
MAINTAIN EROSION AND SEDIMENTATION CONTROL PER CITY AND SWMMW STANDARD
ESC REQUIREMENTS
REQUIREMENTS.
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.
INSPECTIONS
INSPECTION TYPE DATE
RESULT
NOTES
COMPLETE
E-2 SIDE SEWER
X-2 ENGINEERING FINAL"
Printed: Wednesday, September 07, 2022 3:49:15 PM 2 of 2