ENG2021-0241 SIDE SEWER PERMITPERMIT
PERMITNUMBER,
City of Edmonds
EdmondsSEWER
98020 1 1Li
www.cityofedmonds.gov
Description: DIRT CHEAP INSTALL CLEANOUT OUTSIDE HOUSE ISSUED: 07/01/2021
Address: 18810 92ND AVE W EDMONDS WA 98020-2316
EXPIRES: 09/29/2021
Permit Subtype: PARTIAL LINE
Permit Type: SEWER Parcel Number: 00588600000500
REPLACEMENT
CONTACTS
NAME TYPE NAME ADDRESS PHONE
APPLICANT DIRT CHEAP 19212 HWY 99, Lynnwood WA 98036 (360)641-1932
CONTRACTOR DIRT CHEAP 19212 HWY 99, Lynnwood WA 98036 (360)641-1932
OWNER ZOLLMAN THEODORE 18810 92ND AVE W, EDMONDS WA 98020-2316
MCKINLEY&MARIANNE MOORE
M � FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $40.00
SIDE SEWER PERMIT - PARTIAL REPLACEMENT $110.00 $110.00
•
REQUIREMENT TYPE
NOTES
TRAFFIC CONTROL Traffic control and public safety shall be in accordance with City regulations as required by the City
Engineer. Every flagger must be trained as required by WAC 296-155-305 and must have certification
verifying completion of the required training in their posession.
RESTORATION Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with
asphalt or City approved material prior to the end of the workday - No Exceptions
WARRANTY The contractor is responsible for workmanship and materials for a period of one year following the final
inspection and acceptance of the work.
INSPECTION SCHEDULING: WWW.MYBUILDING PERMIT.COM
24 HR NOTICE REQUIRED
INDEMNITY
The Applicant has signed an application which states he/she holds the City of Edmonds harmless from injuries, damages or claims of
any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or any of its departments
or employees, including but not limited to the defense of any legal proceedings including defense costs and attorney fees by reason of
granting this permit.
RELEASED BY
THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW
7/1 /2021
DATE
Printed: Thursday, July 01, 2021 12:50:07 PM 1 of 2
PERMIT
PERMIT NUMBER
City of Edmonds
EdmondsSEWER
98020ENG2021-0241
www.cityofedmonds.gov•
CONDITIONS
CONDITION TYPE
NOTES
It is the owner's responsibility to repair/replace all damage of utilities or frontage improvements in
DAMAGE TO FRONTAGE
City right of Ways or Easements to City Standards caused by or occurring during the permitted
IMPROVEMENTS
project.
ESC REQ
Maintain erosion and sedimentation control per City and SWMMW standard requirements.
INSP PRIOR TO BACKFILL
Call for all required inspections. All work shall be inspected prior to backfill.
Owner/Contractor to provide Side Sewer asbuilt at final inspection. See City Handout E71 for
SEWER ASBUILT
requirements.
All utilities shall be located prior to any excavation. New locates shall be called for if at time of
UTILITY LOCATES
excavation, original locates are no longer identifiable.
INSPECTIONS
INSPECTION TYPE DATE
RESULT
NOTES
COMPLETE
E-2 SIDE SEWER
X-2 ENGINEERING FINAL"
Printed: Thursday, July 01, 2021 12:50:07 PM 2 of 2
SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name: Dirt Cheap Inc. Site Contact: Angel Cervantes
Company Address: Phone #: 425-512-9652
2615 Russell Way #3
City: Everett Zip: 98204 Email #: Katheryn@dirtcheapinc.com
State License # DIRTCCI836BT City Business License # Thru Dept of Revenue UBI 604067211
Expiration Date: 1/30/2023
PROPERTY INFORMATION:
Address:
18810 92nd Ave. W., Edmonds WA 98020
Owner's Name:
Ted & Marianne Zollman
Phone #: 206-799-5867 Marianne; 206-799-5876 Ted
❑ FULL LINE REPLACEMENT ® SPOT REPAIR ❑ PIPE BURST ❑ RELINE (PERMALINE ONLY)
DESCRIPTION OF PROPOSED WORK (Be Specific):
Installing a maintenance clean -out so that access is easier for future jetting of the sewer line based on its length.
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ISSUANCE OF TIIIS PERMIT DOES NOT CONSTITUTE, PIRMISSION TO WORK ON ANY PROPERTY OTHER
TIIAN THAT OWNED I3Y 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.
SIGNATURE /l ?!�
Co tractor r Agent
DATE 7/1/2021
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE