ENG2023-0410 SEWER PERMITSEWER PERMIT
PERMIT NU BE
City of • • .
Edmonds:i 1 14 1
www.edmondswa.gov i
Description: SEWER - SPOT REPAIR ON PRIVATE PROPERTY ISSUED: 08/14/2023
Address: 1123 5TH AVE S EDMONDS WA 98020-4601
EXPIRES: 11/12/2023
Permit Subtype: PARTIAL LINE
Permit Type: SEWER Parcel Number: 27032500214400
REPLACEMENT
CONTACTS
NAME TYPE NAME ADDRESS PHONE
APPLICANT AARON PALMEN 6321 7TH AVE S., SEATTLE WA 98108
(253)405-7765
CONTACT ROTO ROOTER SERVICE COMPANY 6321 7TH AVE S., SEATTLE WA 98108
(253)405-7765
CONTRACTOR ROTO ROOTER 6321 7th Ave S, Seattle WA 98108
(206)510-5237
OWNER JOHN & JOANN MANSFIELD 8238 NE 115TH PL, KIRKLAND WA 98034
A 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: WHJ DATE: 08114/2023
Printed: Monday, August 14, 2023 11:36:57 AM 1 of 2
Printed: Monday, August 14, 2023 11:36:57 AM 2 of 2
SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: Roto-Rooter Services Company Site Contact: Brandon
Company Address: 4630 16TH St E Suite 139
4630 16TH St E Suite B9 _
City: Fife Zip: 98424
state License # ROTORSC122BR
Expiration Date: 4/7/24
PROPERTY INFORMATION:
Address: 1123 5th Ave S
Owner's Name: Laurel Apts
Phone #:
Phone #: (253)405-4409
Email #: jason.windham@rrsc.com
City Business License # NR-026552
DULL LINE REPLACEMENT OPOT REPAIR []PIPE BURST RELINE (PERMALINE ONLY)
DESCRIPTION OF PROPOSED WORK (Be Specific): Emergency spot repair of side sewer. All work on private property.
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. J *�
SIGNATURE DATE r J
Contractor or Agent
CITY OF EDMONDS M BuildingPermit.com
Utilities Application #1361817 - Laurel
Applicant
First Name Last Name Company Name
Aaron Palmen Roto Rooter Service Company
Number Street Apartment or Suite Number E-mail Address
6321 7th Ave S. aaron.palmen@rrsc.com
City State Zip Phone Number Extension
Seattle WA 98108 (253) 405-7765
Contractor
Company Name
ROTO ROOTER SERVICES CO
Number Street Apartment or Suite Number
6321 7th Ave S
City State Zip Phone Number Extension
Seattle WA 98108 (253) 405-7765 (253) 568-7100
State License Number License Expiration Date UBI # E-mail Address
ROTORSC122BR 4/7/2024 FD1 D57.1R1 aaron.palmen@rrsc.com
Project Location
Number Street Floor Number Suite or Room Number
1123 5TH AVE S
City Zip Code County Parcel Number
EDMONDS 98020 27032500214400
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
John & Joann Mansfield
Number Street Apartment or Suite Number
8238 NE 115TH PL
City State Zip
KIRKLAND WA 98034
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: 8/14/2023 Submitted By: Aaron Palmen
Page 1 of 2
CITY OF EDMONDS M BuildingPermit.com
Utilities Application #1361817 - Laurel
Project Contact
Company Name: Roto Rooter Service Company
Name: Aaron Palmen Email: aaron.palmen@rrsc.com
Address: 6321 7th Ave S. Phone #: (253) 405-7765
Seattle WA 98108
Project Type Activity Type Scope of Work
Single Family Residential Utility Modification Partial Line Replacement
Project Name: Laurel
Description of Work: Emergency spot repair of side sewer. All work on private property.
Project Details
Structure Type
Single Family Dwelling
Project Information
Repair
Page 2 of 2