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_ ° CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
Inc. 1 R90
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20150200
SIDE SEWER PERMIT (I -Single Family)
Permit Number: ENG20150200 Expiration Date: 08/11/2015
Job Address: 23201 75TH PL W, EDMONDS
PRICOR TECHNOLOGIES LLC PRICOR TECHNOLOGIES LLC
2825 South 154Th Street 2825 South 154Th Street
SEATTLE, WA 98188 SEAT 1'LE, WA 98188
LICENSE #: PRICOTL865KZ EXP: 05/09/2016
Y
N
DESCRIPTIONJOB
REPAIR N PROPOSETOREUSE LATERAL LID NUMBER
GRINDER PUMP N I PROPOSE TO REUSE SIDE SEWER F N DRAINAGE
perma liner 36 ft
EASENIENTINFORNIATION
N
PROJECT CROSSES OTHER PRIVATE PROPERTY
N
I VERIFICATION OF RECORDED EASEMENTS COMPLETE
IADEMATTY The Applicant has signed an application which states he/she holds the City of Edmonds harmless from injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorney fees by reason ofgranting this permit.
CALL DUL-A-DIG (1-800424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
THIS APPLICATION IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT,IS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Tuesday, May 12, 2015
R DATE
XFILECOPY
❑ INSPECTOR COPY
❑ APPLICANT COPY
31,
STATUS: ISSUED
ENG20150200
• Refer to City of Edmonds Side Sewer Information handout for approved pipe materials, inspections and other requirements.
• A 6" cleanout with 12" locking cast iron lamphole cover is required at the property line.
• Maintain 10'separation between the sanitary side sewer and the water service line.
• A separate right-of-way construction permit is required for work within the City right-of-way.
• Condition of the existing lateral to be verified by the City's Public Works Dept. to obtain approval for reuse. Contact Edmonds
Sewer Division at 425-771-0235.
• Condition of the existing sanitary side sewer to be verified prior to obtaining approval for reuse. TV inspection required. Video
to be submitted to City for review.
• Easement and/or permission from adjacent property owner is required prior to entry/work within adjacent property.
• Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way per City standards that is
caused by or occurs during the permitted project.
• Owner/Contractor to provide Side Sewer asbuilt at final inspection. See City Standards for requirements.
• Sound/Noise originating from temporary construction sites as a result of construction activity are exempt from the noise limits
ofECCChapter5.30only during the hours of7:00amto 6:00pmon weekdays and 10:00amand 6:00pmon Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must comply with the
noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
• Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend. and hold
harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance not limit in any way the City's ability to enforce any ordinance
provision.
INSPECTION'S
• E Sanitary Side Sewer Inspection
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
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CITY OF EDMONDS
SIDE SEWER PERMIT APPLICATION
CONTRACTOR INFORMATION:
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Contact Phone #:
Site Contact.
Contact Phone #:
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MailingAddress: g S S
E-mail address:
State License #: %��`�Lof% 5k2- Expiration Date:
Fax #:
City Business License #.:
Liability Insurance ❑ Bonded
PROPERTY INFORMATION:
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Address:
Owner's Name: L✓c j l�
Contact Phone * .
❑ Fu'I Line Replacement
Spot Repair
❑. Pipe Burst Reline (Perma Line Only)
DESCRIPTION
OF PROPOSED
WORK - BE SPECIFIC
SIGNATURE:. 6-5: DATE:
Contractor or Agent
C:\Users\RosslDocuments\JAt IA
sewer form 1-22-15.docx..