ENG2022-0037+SIGNED APP+2.2.2022_9.14.33_AM+2656258SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: CADB Catalyst Construction Gr( Site contact: Alex Kushner
Company Address: 130 E. Randolph Street, Suite 2100 Phone #:206-900-2395
130 E. Randolph Street, Suite 2100
City: Chicago Zip:60601 Email#: akushner@catalystconstructiongrp.co
State License # 604 519 175 City Business License # 604 519 175 - 001
Expiration Date: October31,2022
PROPERTY INFORMATION:
Address` 21200 72nd Avenue W, Edmonds, WA
Owner's Name: JAS Group LLC tel# 218-818-8386
Phone #:
✓ kLL LINE REPLACEMENT SPOT REPAIR []PIPE BURST RELINE (PERMALINE ONLY)
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DESCRIPTION OF PROPOSED WORK (Be Specific):
Sewer connection
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. _W,
SIGNATURE DATE 2.2.2022
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE