ENG20190295 - App & Permit.pdfOF Cv o�N
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20190295
SIDE SEWER PERMIT (2-Multi-Faniily)
Permit Number: ENG20190295 Expiration Date: 08/24/2019
Job Address: 300 2ND AVE N #3H, EDMONDS
ACES FOUR CONSTRUCTION ACES FOUR CONSTRUCTION
18008 BELLFLOWER ROAD 18008 BELLFLOWER ROAD
BOTHELL, WA 98012 BOTHELL, WA 98012
(206) 22 7-5243
LICENSE #: ACESFCCO14NW EXP: 05/01/2020
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N
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REPAIR N PROPOSE TO REUSE LATERAL LID NUMBER--
GRINDER PUMP N I PROPOSE TO REUSE SIDE SEWER FN 1 DRAINAGE
Spot repair of eadsting 6" concrete. Gras Co. bored thru pipe.
• y ly I '
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PROJECT CROSSES OTHER PRIVATE PROPERTY
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VERIFICATION OF RECORDED EASEMENTS COMPLETE
INDEMNITY- 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 DIAL -A -DIG (1-800424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 H O UR NO TICE REQ UIRID FO R ALL INS PEC TIO N REQ UES TS
THIS APPLICATION IS NOTA PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed:
SED BY DATE
June 24.201
0 FILE COPY ❑ INSPECTOR COPY ❑ APPLICANT COPY
STATUS: ISSUED
ENG20190295
• 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 workwithin 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 percussion 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 fromtemporary construction sites as a result of construction activity are exempt fromthe noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 6:00pm on weekdays and 10:00am and 6:00pm on 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 inderrmify 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 pen -nit 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.
INS PECTIONS I
• E-Asbuilt
• E-Sanitary Side Sewer Inspection
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
C,~�y of EVAfo
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CONTRACTOR INFORMATION:
SIDE SEWER
PERMIT APPLICATION
Company Name:AC-f--C, C-C-1wL CUVNS1 , Site Contact: UnrAr-Y (-; OCIAL A
Company Address: Phone #:
1 cos d�«Ftow �.� L� 906 - as
City: 30-%� t � Zip: 1 801 r-L
State License # Aces r'cr—U IL(
Expiration Date: S _ ( _ 00 CAC.)
PROPERTY INFORMATION:
Email #: rl +`ov\a.%, ,- gG-^)/ J g oa%t • C.011-
City Business License # A 1 C:>;76 7 70"'->
Address:
Owner's Name: �•J
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Phone #: ? /_,.., . ?aa - C09
❑ FULL LINE REPLACEMENT SPOT REPAIR ❑ PIPE BURST ❑ RELINE (PERMALINE ONLY)
DESCRIPTION OF PROPOSED WORK (Be Specific):
SPor ���,�-�,z �C� �sr���► G'' Cov,,cfr�.
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 ZRSPRESS PERMISSION TO PERFORM WORK ON THAT ADJACENT
PROPERTY.
SIGNATURE DATE K U I Cl
ContAnefor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE