ENG2022-0336+City_Application+6.24.2022_12.34.34_PM+2953195SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: Encore Construction, LLC
Company Address: 7910 123rd Ave NE
7910 123rd Ave NE
City: Lake Stevens Zip: WA
State License # ENCORCL857K6
Expiration Date: 12/14/2023
PROPERTY INFORMATION:
Site contact: Dimitri Lokhmatov
Phone #: (425) 359-9896
Email": dlokhmatov@gmail.com
City Business License # N R-026079
Address` 23511 74th Ave W Edmond, WA 98026
Owner's Name: (425) 830-1046
Phone #:
[JULL LINE REPLACEMENT POT REPAIR []PIPE BURST RELINE (PERMALINE ONLY)
DESCRIPTION OF PROPOSED WORK (Be Specific): Install 6" clean out as shown on attached site plan for future video
inspection to be performed by city. a
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.
SIGNATURE
DATE 06/24/2022
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE