ENG2022-0557+City_Application+11.15.2022_4.24.47_PM+3221889,4,.jOf EDA,,vIV
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CONTRACTOR INFORMATION:
SIDE SEWER
PERMIT APPLICATION
Company Name: Quantum Homes LLC
%-ompany Aaaress: 1226 169th PI SW
1226 169th PI SW
City: Lynnwood Zip:98037
State License # QUANTHL806BW
Expiration Date: 02-05-2024
PROPERTY INFORMATION:
Address: 70rl l 7A n+h ► f
Contact: Balwant Aulck
#:206-571-7777
t n'" #: balwantauick@gmail.com
City Business License #
. - - . -
i sr v
Owner's Name: Twin Rik
LLC - Balwant Aulck
Phone #:
DULL LINE REPLACE
HENT DPOT REPAIR []PIPE BURST RELINE (PERMALINE ONLY)
DESCRIPTION OF PROPOSED
WORK (Be Specific):
New connection to City
system
ISSUANCE OF THIS PERM
DOES NOT CONSTITUTE PERMISSION TO WORK ON ANY PROPERTY OTHER
THAN THAT OWNED BY
E SUBJECT PROPERTY OWNER.
i
CERTIFICATIONS NECESSARY
FOR INSTALLATION METHODS ARE THE RESPONSIBILITY OF THE
CONTRACTOR PERFORMI
G SAID WORK.
I REPRESENT AND WA
ADJACENT PROPERT
T TO THE CIT OF EDMONDS, IF REPAIR OF EXISTING SEWER EXTENDS TO AN
kVEqWNERSfXP4ESS PERMISSION TO PERFORM WORK ON THAT AnIACFNT
rmkjrrtlt Y.
SIGNATURE DATE l `
Contractor or nt
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE