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SideSewerPermitApplicationLot1_23517_04062020SIDE SEWER PERMIT APPLICATION CONTRACTOR INFORINIATION: Company Name: �?G��Z��—��23a �f7t.�L Site Contact: ��p�W ��% Company Address:. Phone #: z� City: _ Zip: a r- Email State License # © City Business License # �1 _ 1127,120 Expiration Date: 3 /! PROPERTY INFORMATION: Address: � -�55}7 Owner's Name:✓Lt Phone #: 2-6 1- ❑ FULL LINE REPLACEMENT ❑ SPOT REPAIR ❑ PIPE BURST ❑ RELINE (PERMALINE ONLY) DESCRIPTION OF PROPOSED WORK (Be Specific): 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 HAVE OWNS RESS PERMISSION TO PERFORM WORK ON THAT ADJACENT PROPERT . SIGNATURE DATE Contractor or Agent NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE