ENG2024-0185+City_Application+4.24.2024_1.13.46_PM+4216655SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: Landsverk Quality Homes, Inc. Site contact: Erik Landsverk
Company Address: 24113 56th Ave W Phone #: 425-478-1495
24113 56th Ave W
City: Mountlake Terrace zip: 98043 Email #: erik@lqh-inc.com
State License # 601855300 City Business License # 601855300-001-0002
Expiration Date: 5-31-24
PROPERTY INFORMATION:
Address: 18809 94th Ave W, Edmonds, WA 98020
Owner's Name:
Landsverk Quality Homes, Inc.
Phone #:
W�ULL LINE REPLACEMENT SPOT REPAIR []PIPE BURST RELINE (PERMALINE ONLY)
---------------
DESCRIPTION ?-.A?-.A?-.AMI
OF PROPOSED WORK (Be Specific): New sewer tap (or verify and use existing tap) of sewer main located in existing
q I
private access easement on the south side of the lot.
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.
"signed b' Joseph
Rowett
SIGNATURE Joseph Rowe t o e zo 4 2413r0 I13�-0-0TW bo CNaJ seG�Rulin Homes. DATE 4-24-24
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE