ENG2022-0554+City_Application+11.15.2022_4.33.43_PM+3221915of EV&104"
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SIDE SEWER
INC. I g90
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: Quant
m Homes LLC Site Contact: Balwant Aulck
Company Address: 1226
169th PI SW Ph
ne #•206-571-7777
#: balwantaulck@gmail.com
Business License #
1226 169th PI SW
City: Lynnwood
Zip: 98037 Entail
State License # QUANTHL806BW
Chy
Expiration Date: 02-05-2024
PROPERTY INFORMATION:
Address: 7905 240th GJ
o ner'sName: Twin Pi
r
LC - Balwant Aulck
Ph�ne #:
[JULL LINE REPLACE
TENT
DPOT REPAIR PIPE BURST RELINE (PERMALINE ONLY)
DE 3CRIPTION OF PROP
D WORK (Be Specific):
a
New
connection to Cit
tem
t
a
ISSUANCE OF THIS PERMIT
OES NOT CONSTITUTE PERMISSION
TO WORK ON ANY PROPERTY OTHER
THAN THAT OWNED BY T E
SUBJECT PROPERTY OWNER.
CERTIFICATIONS NECES R
FOR INSTALLATION METHOD
ARE THE RESPONSIBILITY OF THE
CONTRACTOR PERFORMING
SAID WORK.
I REPRESENT AND WARR N
ADJACENT PRO PERL
TO THE CITY OF EDMONDS, IF
EPAIR OF EXISTING SEWER EXTENDS TO AN
O RS EXPRESS PERMISSION
TO PERFORM WORK ON THAT ADJACENT
PROPERTY.
SIGNATURE
rr-
DATE 1-2-Z
ctor o ge
0
Contr
NO
WORK SHALL BEGIN PRIOR TO
PERMIT ISSUANCE