ENG2024-0143+City_Application+3.29.2024_8.19.27_AM+4164662SIDE 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: 8823 194th St SW, Edmonds, WA 98026
Owner's Name:
Landsverk Quality Homes, Inc.
Phone #:
W�ULL LINE REPLACEMENT SPOT REPAIR [:]PIPE BURST RELINE (PERMALINE ONLY)
--------------------------
DESCRIPTION OF PROPOSED WORK (Be Specific): New sewer tap and side sewer from Main in 194th St SW to new single family
I
residence. New clean out to be located at property line and at new house.
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 Ro-uswett Q
SIGNATURE Joseph Rowe? 28081-ph�8I12�-0-0TWboCNaJseG�RulinHomes. DATE 3-2Q-24
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE