ENG2023-0557+SIDE SEWER+City_Application+11.1.2023_11.05.54_AM+3874159SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: D L H I N C
Company Address:
City: North Bend Zip:98045
State License # DLHIN**072B5
Expiration Date: 03/30/24
PROPERTY INFORMATION:
Address: 15604 75th PI W, Edmonds, WA 98026
Owner's Name:
Hartanah KL, LLC
Phone #:
Site Contact: ,Jason Holub
Phone #: 425-985-2862
Email #: Jason@dlhinc.com
City Business License # 601426869
04/30/2024
DULL LINE REPLACEMENT SPOT REPAIR [:]PIPE BURST RELINE (PERMALINE ONLY)
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 PROPER'",' T HAVE OWNERS EXPRESS PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY.
SIGNATURE DATE 10/5/23
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE