ENG2023-0198 SEWER PERMITPERMIT
PERMIT NU
City •EdmondsSEWER
121 Sth Ave N, Edmonds WA :0• .
www.edmondswa.gov i
Description: SEWER -INSTALL LINER ISSUED: 04/11/2023
Address: 520 12TH AVE N EDMONDS WA 98020-2932
EXPIRES: 07/10/2023
Permit Subtype: PARTIAL LINE
Permit Type: SEWER Parcel Number: 00535600000600
REPLACEMENT
CONTACTS
NAME TYPE NAME ADDRESS PHONE
APPLICANT RICHARD BENTZ 1528 169TH PL SW, LYNNWOOD WA 98037
(425)418-7142
CONTACT STRICTLY SEWERS INC 1528 169TH PL SW, LYNNWOOD WA 98037
(432)327-9504
CONTRACTOR STRICTLY SEWERS INC 10811 HOLLY DR, EVERETT WA 98204
(425)418-7142
OWNER LOREN FORSBERG 520 12TH AVE N, EDMONDS WA 98020-2932
AW, FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE - PER PERMIT $45.00 $45.00
SIDE SEWER PERMIT - PARTIAL REPLACEMENT $126.00 $126.00
REQUIREMENTS
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
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.
RELEASED BY: GRN DATE: 04/11/2023
Printed: Tuesday, April 11, 2023 1:00:43 PM 1 of 2
SEWER PERMIT
PERMIT NUMBER
City of Edmonds
www.edmondswa.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
7SIDE
RESULT NOTES
COMPLETE
R
X-2 ENGINEERING FINAL"
E-2 TV AND WATER TEST
Printed: Tuesday, April 11, 2023 1:00:43 PM 2 of 2
SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: Strictly Sewers Inc
Company Address: 1528 169th PI SW
1528 169th PI SW
City: Lvnnwood Zip:98037'
State License # stricsi925jd
Expiration Date: 041824
PROPERTY INFORMATION:
Address: 520 12th Ave N
Owner's Name:
Loren Forsberg
Phone #:
Site Contact: Darrin Baker
RECEIVED
Apr 11 2023
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
Phone #:425-327-9504
Email #: strictlysewers@hotmail.com
City Business License # N/A
FULL LINE REPLACEMENT SPOT REPAIR PIPE BURST �✓ RELINE (PERMALINE ONLY)
s
DESCRIPTION OF PROPOSED WORK (Be Specific): Excavating on SW corner of house. Install patch
to repair the offset. Install liner upstream to the cast. Install liner downstream to the 4" to 6"
;:exterior clean out.
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 PROP 7 TY,:1jIAVE.OWNIERS EXPRESS PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY.
/ L
i SIGNATURE `� � DATE 04/10/2023
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
RECEIVED
CITY OF EDMONDS
Utilities Application #1296588 - Forsberg
Apr 11 2023
M Buildin Permit.com CITY OF EDMONDS
y DEVELOPMENT SERVICES
DEPARTMENT
Applicant
First Name Last Name Company Name
Richard Bentz Strictly Sewers Inc
Number Street Apartment or Suite Number E-mail Address
1528 169th PI SW strictlysewers@hotmail.com
City State Zip Phone Number Extension
Lynnwood WA 98037 (425) 418-7142
Contractor
Company Name
STRICTLY SEWERS INC
Number Street Apartment or Suite Number
10811 Holly Dr
City State Zip Phone Number Extension
Everett WA 98204 (425)418-7142
State License Number License Expiration Date UBI # E-mail Address
STRICS1925JD 4/18/2024 strictlysewers hotmail.com
Project Location
Number Street Floor Number Suite or Room Number
520 12TH AVE N
City Zip Code County Parcel Number
EDMONDS 98020 00535600000600
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
Loren Forsberg
Number Street Apartment or Suite Number
520 12TH AVE N
City State Zip
EDMONDS WA 98020-2932
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: 4/10/2023 Submitted By: Richard Bentz
Page 1 of 2
i
CITY OF EDMONDS MyBuildingPermit.com
Utilities Application #1296588 - Forsberg
Project Contact
Company Name: Strictly Sewers Inc
Name: Darrin Baker Email: strictlysewers@hotmail.com
Address: 1528 169th PI SW Phone #: (432) 327-9504
Lynnwood WA 98037
Project Type Activity Type
Single Family Residential Utility Modification
Project Name: Forsberg
Description of Work: Install liner upstream and downstream
Project Details
Structure Type
Single Family Dwelling
Project Information
Repair
Scope of Work
Partial Line Replacement
Page 2 of 2