ENG2023-0547+SEWER+City_Application+10.24.2023_11.22.14_AM+3857578DocuSign Envelope ID: 334FF163-1EB8-4DF3-98C4-E4634C644DA9
SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: SPH Construction Inc Site Contact:
Company Address: 2505 92nd PI SE Phone #:(425)870-1292
City: Everett Zip:98208 Email #: yura1203@gmail.com
State License # SPHCOC183ODG City Business License #
Expiration Date: 04/11 /2025
PROPERTY INFORMATION:
Address:18230 91 st Ave W, Edmonds WA 98026
Owner's Name: Sofia Bolotin, Vladimir Bolotin
Phone #:
DULL LINE REPLACEMENT DPOT REPAIR OIPE BURST RELINE (PERMALINE ONLY)
DESCRIPTION OF PROPOSED WORK (Be Specific):
A new cleanout to be installed.
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. 000us yoea by:
SIGNATURE -zo C"-d- DATE
oniracror or°Agent
10/24/2023 1 11:17 AM PDT
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE