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X {a I7TILITIES CITY OF EVERETT <br /> � 5 nom` <br /> '� ' PERMIT SERVICES" <br /> .,f--�, % PE IT <br /> 3200 CEDAR STREET <br /> . <br /> EVERETT WA 98201 = " <br /> i (425)257-8810 <br /> PERMIT NUMBER U1901-028 DATE 21 <br /> JA N <br /> 913 <br /> JOB ADDRESS 2719 21ST ST LEGAL DESCRIPTION ^ , <br /> DESCRIPTION SIDE SEWER REPAIR APN: 00553100901800 <br /> OWNER ETHERINGTON KARY L&SHELLEY RAE TENANT <br /> 2 <br /> 2719 21ST ST <br /> E 1ST, WA 98201 CONTRACTOR' ROTO ROOTER SERVICES CO <br /> 10655 INTERNATIONAL BLVD <br /> PHONE_ <br /> TUKWILA WA 98168 <br /> PHONE 4257732257 <br /> WATER SERVICE <br /> SERVICE SIZE SERVICE TYPE. FRONTAGE. NO.OFUNITS <br /> SERVICE ORDER NO- APPLICATION NO <br /> SETTER INSTALLATION DATE BY.-.. <br /> METER NO. SIZE #1 BACKFLOW DEVICE'SERIAL SO. - <br /> RF.NO. I P2 BACKFLOW DEVICE SERIAL NO. <br /> BRAND <br /> MODEL NO. <br /> METERISTALLATION DATE .,BY - <br /> WATER ON OFF_ LOCKED OUT -.:BY . ;"r, ip i <br /> TSG . . <br /> r—. <br /> ,:. .. .;:. <br /> f'L} <br /> SEWER.SERVICE ...5'..I <br /> PERMIT NO <br /> PERMIT TYPE REPAIR I LID NO. '` ,, <br /> SP-17932 <br /> REMARKS: Please Note:The City is responsible for structural defects in the side sewer on the City ROW side per EMC 14.0§42 .r,p, S <br /> - SIDE SEWER REPAIR r=� t=a <br /> acs <br /> 08 co x: <br /> INSPECTED BY: ❑C] <br /> DATE = t--`..�... <br /> PEES <br /> SEWER UTILITY FEE $30.00 <br /> TOTALFEES $30.00 <br /> I`PERMIT NUMBER U1901-028 <br /> ADDRESS COPY <br />