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CONTRACTOR INFORMATION:
SIDE SEWER
PERMIT APPLICATION
Company Name: Maston Properties Site Contact: Margo Henson
Company Address: 2020 Maltby Road #7 PMB 116 Phone #: 206-784-6627
2020 Maltby Road #7 PMB 116
City: Bothell Z'P: 98021 Email #: margo@marketappraisalinc.com
State License # MASTOPCC912L5 City Business License #
Expiration Date: 6/20/25
PROPERTY INFORMATION:
Address` 23620 79the Ave West
Owner's Name:
Margo Henson
Phone #:
[JULL LINE REPLACEMENT SPOT REPAIR []PIPE BURST RELINE (PERMALINE ONLY)
DESCRIPTION OF PROPOSED WORK (Be Specific):
Add approx. 48 feet of new side sewer connecting the proposed garage conversion to the existing
side sewer at the side of the existing house and replace existing 4" line from house to street with new 6" line.
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 Tom Leren for Leren Co. Inc./ agent to Margo HensorbATE 7/25/24
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE