ENG2023-0281+City_Application+6.14.2023_7.51.54_AM+3607943DocuSign Envelope ID: C2A6BAD7-F69D-455E-8DF7-17C2A24D0114
SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: Cedar One Construction LLC. Site contact: Ryan Shelley
Company Address: 100 2nd Ave S Suite 200 Phone #:360-320-2376
100 2nd Ave S Suite 200
City: Edmonds ZiP:98020 Email #: ian.joseph@thejosephgroup.com
State License # HUDSOCM84603 City Business License #
Expiration Date: 09/23/2024
PROPERTY INFORMATION:
Address` 8023 215th Place SW, Edmonds, Wa 98026
Owner's Name:
Ian Joseph
Phone #:
DULL LINE REPLACEMENT POT REPAIR [JIPE BURST RELINE (PERMALINE ONLY)
iE
iE
DESCRIPTION OF PROPOSED WORK (Be Specific):
Relocation of existing side sewer from the back of the house to the side of the house
and installing a new cleanout. Removing sewer line behind house for proposed addition.
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. Docusigned by:
SIGNATURE � DATE 6/13/2023
1230388OWWAttor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE