Engineering Permit FormSEWER PERMIT
PERMIT NU
'
City of • • .
:i 1 C 1
EdmondsIE
www.edmondswa.gov i
Description: SEWER -INSTALL CLEANOUT/EXTENSION FOR BOLOTIN ADDITION
ISSUED: 10/27/2023
Address: 18230 91ST AVE W EDMONDS WA 98026-5312
EXPIRES: 01/25/2024
Permit Subtype: PARTIAL LINE
Permit Type: SEWER Parcel Number: 27041800200300
REPLACEMENT
CONTACTS
NAME TYPE NAME ADDRESS PHONE
APPLICANT SOFIA BOLOTIN 18230 91ST AVE W, EDMONDS WA 98026
(425)551-9193
CONTACT SOFIA BOLOTIN 18230 91ST AVE W, EDMONDS WA 98026
(425)551-9193
CONTRACTOR SPH CONSTRUCTION INC 2505 92ND PL SE, EVERETT WA 98208
(425)870-1292
OWNER SOFIA & VLADIMIR BOLOTIN 18230 91ST AVE W, EDMONDS WA 98026 (425)551-9193
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: NED DATE: 10/27/2023
Printed: Friday, October 27, 2023 11:07:04 AM 1 of 2
SEWER PERMIT
PERMIT NU �!B E
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.
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.
INSPECTION TYPE
DATE RESULT
NOTES
ir
COMPLETE
E-2 SIDE SEWER
X-2 ENGINEERING FINAL"
Printed: Friday, October 27, 2023 11:07:04 AM 2 of 2