ENG2023-0562+City_Application+11.2.2023_12.29.19_PM+3877387SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: Homeowner Site Contact: Claire Hinman and Alex Turpin
Company Address: Phone #: (360) 367-0077
City: zip: Email #: clairehinman@gmail.com
State License # City Business License #
Expiration Date:
PROPERTY INFORMATION:
Address: 17715 76th Ave W, Edmonds, WA 98026
Owner's Name:
Claire Hinman and Alex Turpin
Phone #: (360) 367-0077
DULL LINE REPLACEMENT ZSPOT REPAIR [:]PIPE BURST RELINE (PERMALINE ONLY)
DESCRIPTION OF PROPOSED WORK (Be Specific): Sewer cleanout to be relocated to outside of new deck for access.
Verify location in the field.
OF
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 7 v ' DATE 09/13/2023
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE