ENG2023-0434+City_Application+8.23.2023_2.33.07_PM+3743460SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: Landsverk Quality Homes, Inc. Site contact: Duane Landsverk
Company Address: 24113 56th Ave. W. Phone #: 425-754-2069
24113 56th Ave. W.
City: Mountlake Terrace ZiP: 98043 Email #: duane@LQH-inc.com
State License # LANDSQH823JN City Business License # 601855300-001-0002
Expiration Date: 4/16/25 5/31/24
PROPERTY INFORMATION:
Address: 19515 94th PI. W., Edmonds, WA 98020
Owner's Name:
Duane & Deanne Landsverk
Phone #:
W�ULL LINE REPLACEMENT SPOT REPAIR []PIPE BURST RELINE (PERMALINE ONLY)
DESCRIPTION OF PROPOSED WORK (Be Specific): Per application for Building Permit #BLD223-0623
SIDE SEWER GOING INTO EXISTING MANHOLE IN AN ROW (EXCELSIOR PLACE) THAT DOES IS NOT UP TO CURRENT ROAD STANDARDS
SEE ATTTACHED
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.
Deanne Landsverk Digitally signed by Deanne Landsverk 8/23/23
SIGNATURE Date: 2023.08.23 14:22:48-07'00' DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE