ENG2023-0395+City_Application+8.1.2023_10.37.16_AM+3700142SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: Landsverk Quality Homes, Inc.
Company Address: 24113 56th Ave W
Site contact: Erik Landsverk
Phone #: 425-478-1495
24113 56th Ave W
City: Mountlake Terrace zip: 98043 Email #: erik@lqh-inc.com
State License # LANDSQH023JN
Expiration Date: 4-16-25
PROPERTY INFORMATION:
Address: 19128 94th Ave W, Edmonds, WA 98020
Owner's Name:
Landsverk Quality Homes, Inc.
Phone #:
City Business License # 601855300
W�ULL LINE REPLACEMENT SPOT REPAIR []PIPE BURST RELINE (PERMALINE ONLY)
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DESCRIPTION OF PROPOSED WORK (Be Specific): connection of new single family residence to newly installed
? sewer main associated with permit #BLD 2022-0926. Connection will be made on the West side of the house. a
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.
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SIGNATURE Joseph Rowe?t pae:20 3O0IDr35152�-0-0TW bo CNaJ seG�Rulin Homes. DATE 8-1-23
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE