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s <br />ITY OF EVERETT <br />ILITIES <br />PERMIT SERVICES <br />PERMIT <br />3200 CEDAR STREET <br />EVERETT, WA 98201 <br />(425) 257-8810 <br />PERMIT NUMBER U1804=043 ' <br />DaTE <br />ros ADDRESS 1412 KOSSUTH AVE <br />LEGAL DESCRIPTION <br />DESCRIPTION SIDE SEWER ALTERATION TO SHARE W/ MAIN HOUSE SEP <br />APN. 00394100200300 <br />'OWNER ESCOBEDOINDALECIO <br />TENANT <br />1410 KOSSIITH AVE - <br />EVERETT-` - <br />WA <br />CONTRACTOR OWNER' <br />PHONE <br />PHONE <br />WATER SERVICE . = <br />SERVICE SIZE - <br />SERVICE TYPE <br />-- FRONTAGE- <br />NO. OF UNITS <br />SERVICE ORDER NO, <br />'. APPLICATION NO <br />0.00 <br />BETTER INSTALLATION DATE BY� <br />METER NO '. SIZE <br />#I BACKPLOW DEVICE SERIALNO. <br />- <br />R.F. NO. <br />42BACKFLOWDEVICESERIALNO:- - - - <br />- - <br />BRA� <br />MODEL NO. <br />METER ISTALLATIONDATE . ,..By <br />- - - <br />WATER ON_ OFF_ LOCKED OUT ' BY <br />_, . <br />,. f^? A 1.. . <br />�_3 <br />. <br />h"-° 6--• a..'`S`rG—•�:^-`-i�u+-j--�I <br />REMARK$: <br />: '"w _.t, y;.rD r..r`='e.:r rff .'-s•7 r;:9 = j:.}':);::.t� -•"'+ � -'� <br />SEWER SERV ' Viar <br />, r_ <br />rERnmrxo. SP-17670. <br />�'. <br />PERMIT TYPE , NEW C ECTION: <br />LW No 3 <br />REMARKS: Please Note: The Cityis responsible for structural defects in the � <br />s`t S&Wdn the C s e h =' <br />4 q g $26#t <br />ALTERATION, SHARE W/ MAIN HOUSE SERVICE <br />° '� ' `� "' `' crI ' T r.-D s:- <br />, .,; • i... > ,..p c"a T•._% eL`.>.> c_>.r. <br />r;; `J 3--` -fig <br />MSPECTED BY; - <br />I <br />DATE ` <br />FEES' <br />SEWER UTILITY FEE <br />$30:00 - <br />TOTALFEES <br />$30,00 - <br />PERMIT NUMBER U1804-043 <br />ADDRESS COPY <br />