ENG2024-0361+City_Application+7.15.2024_5.41.34_PM+4379167SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: Accord Contractors
Company Address: 12826 SE 40th LN Suite 204
12826 SE 40th LN Suite 204
City: Bellevue zip:98006
State License # 602700903
Expiration Date: 2/28/2025
PROPERTY INFORMATION:
Site Contact: Kyle Woods
Phone #:425-344-1505
Email #: kyle.woods@edmondswa.gov
City Business License # On -file
Address: 24105 78th PL W, Edmonds, WA 98026
Owner's Name:
City of Edmonds - Parks
Phone #:
W�ULL LINE REPLACEMENT SPOT REPAIR []PIPE BURST RELINE (PERMALINE ONLY)
------------------------------------------
DESCRIPTION OF PROPOSED WORK (Be Specific):
New 6" side sewer serving a 1-stall restroom at Mathay Ballinger Park. Attached to BLD2023-1391
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.
SIGNATURE
DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE