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SideSewerPermitApplicationLot2_23525_04062020QF EDAfo C. 1 sqo CONTRACTOR INFORMATION: SIDE SEWER PERMIT APPLICATION Company Name: i4LkWZL� Site Contact: MAW b� f: L G Company Address:12 3 yr 9 .K Phone #: City: s zip. *— Email #: State License # © City Business License # �! V2740 Expiration Date: PROPERTY INFORMATION: Address: G, ? � �7 75 �/t—rtil.��' C?i\I�� • �� G,tl� Owner's Name: � Phone #: 2-4n !q' V j/ r(o ❑ FULL LINE REPLACEMENT ❑ SPOT REPAIR ❑ PIPE BURST DESCRIPTION OF PROPOSED WORK (Be Specific): �SDN,U�G i ❑ 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 HAVE OWNE,_RSX.XZRESS PERMISSION TO PERFORM WORK ON THAT ADJACENT PROPERT . SIGNATURE DATE Contractor or Agent NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE