ENG2024-0494+City_Application+10.17.2024_4.58.45_PM+4567308SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: TB D Site Contact:
Company Address: Phone #:
City: Zip: Email #:
State License # City Business License #
Expiration Date:
PROPERTY INFORMATION:
Address: 1520 10th Place N
Owner's Name:
Bothell Manor LLC
Phone #:
DULL LINE REPLACEMENT SPOT REPAIR [:]PIPE BURST RELINE (PERMALINE ONLY)
F00000000----------- 001010110d
DESCRIPTION OF PROPOSED WORK (Be Specific): New Single Family Residence. Replacing existing side sewer relining side sewer line.
Relining existing side sewer line for single family residence,
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.
Digitally signed by Bob Bozorth
SIGNATURE Date: 2024.10.17 16:58:17-07'00' DATE 10-17-24
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE