ENG2024-0304+City_Application+6.17.2024_11.48.46_AM+4326692of EV&10
/NC. 1890
CONTRACTOR INFORMATION:
SIDE SEWER
PERMIT APPLICATION
Company Name: Glacier Environmental Services, Site contact: Lauren Golembiewski
Company Address: Phone #:425-268-9775
City: Edmonds Zip:98026 Email #: LMiles@glacierenviro.com
State License # GLACIES108C7 City Business License # 601 225 417
Expiration Date: 1 /14/2026
PROPERTY INFORMATION:
Address: 7509 212th St SW Edmonds, WA 98026
Owner's Name: DRT Holdings LLC
Phone #:
✓FULL LINE REPLACEMENT DPOT REPAIR PIPE BURST ❑RELINE (PERMALINE ONLY)
DESCRIPTION OF PROPOSED WORK (Be Specific):
Replace 6" side sewer following same alignment as shown on civil plans BLD2022-1556
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 O ER XPRESS PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY.
SIGNATURE '
--- DATE
Contract or Agent
\tea
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
BUSINESS LICENSE
Profit Corporation
GLACIER ENVIRONMENTAL SERVICES, INC.
7509 212TH ST SW
EDMONDS WA 98026-7605
UNEMPLOYMENT INSURANCE - ACTIVE
TAX REGISTRATION - ACTIVE
Issue Date: Dec 08, 2023
Unified Business ID #: 601225417
Business ID #: 001
Location: 0001
Expires: Jan 31, 2025
INDUSTRIAL INSURANCE - ACTIVE
CITY/COUNTY ENDORSEMENTS:
KIRKLAND GENERAL BUSINESS - NON-RESIDENT - ACTIVE
BELLINGHAM GENERAL BUSINESS #022919 - ACTIVE
EDMONDS GENERAL BUSINESS - ACTIVE
LICENSING RESTRICTIONS:
Not licensed to hire minors without a Minor Work Permit.
REGISTERED TRADE NAMES:
GLACIER ENVIRONMENTAL SERVICES INC.
This doannent lists the registrations, endorsements, and licenses authorised for the husiwe
named abmr. 9v accepting this doaumenL the licensee certifies the information on the applic cl oo
complete, true, and accurate to the best of his or her knowledge, and lItA business will be
I... -I'd in r npT- nce v ith all applieihlt \N shingtnn st 1R, cotmh and rily rrpulalimn.
UBI: 601225417 001 0001
GLACIER ENVIRONMENTAL
SERVICES, INC.
7509 212TH ST SW
EDMONDS WA 98026-7605
STATE OF WASHINGTON
UNEMPLOYMENT INSURANCE -
ACTIVE
INDUSTRIAL INSURANCE - ACTIVE
TAX REGISTRATION - ACTIVE
KIRKLAND GENERAL BUSINESS -
NON-RESIDENT - ACTIVE
BELLINGHAM GENERAL BUSINESS
#022919 - ACTIVE
EDMONDS GENERAL BUSINESS -
ACTIVE
Expires: Jan 31, 2025