ENG2023-0384+City_Application+7.26.2023_11.52.49_AM+3690116DocuSign Envelope ID: FBC6C5DB-88F0-4DE1-B485-7D21 F2F8DEOC
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CONTRACTOR INFORMATION:
SIDE SEWER
PERMIT APPLICATION
Company Name: Carey Brothers Rockery
Company Address: 2211 SW Lake Roesiger Rd
2211 SW Lake Roesiger Rd
City: Snohomish Zip:98290
State License # CAREYBR936BC
Expiration Date: 1 /11 /2025
PROPERTY INFORMATION:
Address: 840 Daley St. Edmonds WA 98020
Owner's Name:
Peter & Jia Tang
Phone #:
Site contact: Darrald Carey
Phone #: 206-730-9537
Email #: darraldrearey@hotmail.com
City Business License # 0-034-581-163
W�ULL LINE REPLACEMENT SPOT REPAIR []PIPE BURST RELINE (PERMALINE ONLY)
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DESCRIPTION OF PROPOSED WORK (Be Specific): New side sewer for a new home. There is an existing residence that will
, be torn down and we plan to disconnect at the property line and reconnect. 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. pocus goad by:
SIGNATURE
Wffi0t6rQFrFAgent
DATE 07/25/2023
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE