ENG2023-0389_City_Application_7.28.2023_10.02.43_AM_3694645SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: Roto Rooter Services Co Site Contact: Brett Lucero
Company Address: 6321 7th Ave S. Phone #: 253-606-8871
6321 7th Ave S.
city: Seattle zip: 98108 Email #: aaron.palmen@rrsc.com
State License # ROTORSC122BR City Business License # NR-026552
Expiration Date: 04/07/2024
PROPERTY INFORMATION:
Address: 1028 Cascade Ln., Edmonds WA 98020
Owner's Name: Sue Delsignore
Phone #:
DULL LINE REPLACEMENT ®SPOT REPAIR [:]PIPE BURST RELINE (PERMALINE ONLY)
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DESCRIPTION OF PROPOSED WORK (Be Specific): Perform an emergency spot repair on existing side sewer. Straight repair
up to 4' in length. All work on private property.
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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 OWNERS EXPRESS PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY.
Aaron Pa I m e n Digitally signed by Aaron Palmen
SIGNATURE Date: 2023.07.28 09:58:45-07'00'
Contractor or Agent
DATE 7/28/2024
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE