ENG2024-0336+City_Application+7.2.2024_9.23.44_AM+4354553SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: Leif Helleren Construction, Inc. Site Contact: Leif Helleren
Company Address: 23314 Wachusetts Road Phone #: (425)770-1970
23314 Wachusetts Road
city: Woodway zip: 98020 Email #: stevens1043@comcast.net
State License # 601818421 City Business License # 601818421
Expiration Date: 9/30/2024
PROPERTY INFORMATION:
Address: 8908 189th Place SW, Edmonds, WA 98026
Owner's Name: Douglas and Amy Subcleff
Phone #:
FULL LINE REPLACEMENT ❑SPOT REPAIR ❑PIPE BURST ❑RELINE (PERMALINE ONLY)
DESCRIPTION OF PROPOSED WORK (Be Specific): New Sanitary Sewer line from manhole location in Street to the west
side building perimeter as shown on the Architectural Site Plan, Sheet A-1 and on Civil Engineer's Utility Plan in
underground trench as required by City standards.
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. e
SIGNATURE � DATE �o Zfl
Contractor or Agent t
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE