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UTILITIES <br />PERMIT <br />CITY OF EVERETT <br />PERMIT SERVICES <br />3200CEDAR STREET <br />EVERETT, WA 98201 <br />(425)257-8810 <br />PE10111'NUMBER U1503-135 <br />DATE. 3/2512015 <br />JOB ADDRESS 3417 GRAND AVE <br />LEGAL DESCRIPTION <br />DESCRIPTION INSTALL BACKWATER VALVE <br />APN00437582500800 <br />OWNER ALLEN, LES C & SHIRLEY S <br />5657 229TH AVENUE SE <br />ISSAOUAH WA <br />I•IIUf f <br />98029 <br />TENANT <br />CONTRACTOR <br />PNONt <br />MOEN PLUMBING <br />17515 41 ST SP SE <br />SNOHOMISH A 98200 <br />4257608360 <br />WA'1'LR SERVICE <br />SERVICE TYRE !LJ'/�41 I +0 Of 10 �0 I SERVICE ORDER NO I ARRICAT:ONNO <br />NCETER INSTALLATION DATE <br />NCTER NO <br />4L ND_ <br />NMR ISTALLATION DATE BY, <br />u'ATERON_ DEr_ LOLY:EDODT- BY <br />REMARKS <br />EI BAMROK DEVICE SERIAL NO _ <br />L} BACKn OW DEVICE SENAL n0 ._ <br />MODEL NO <br />SEWER SERVICE <br />TSG <br />rcum NO SP-15832 RrR.+cnrrE <br />IID ND <br />REMARKS: Please Note: The City is responsible Iur structEmd drfects I, the side snser on the Co I) It0"'side per ENIC 14.08.260 <br />T <br />iNVE(T[D BY <br />DATE <br />FEES <br />ScSCLN LDhq I'cc 51000 <br />TOTAL FEES $30.00 <br />C� IIII <br />MAR 2 5 2015 �D <br />- <br />i.l 1 Y ���' <br />P P.11 `;,, :ices <br />1 1141,111' NUMBER U1503-135 <br />PUBLIC WORKS COPY <br />