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CITY OF EVERETT <br />UTILITIES <br />PERMIT .SERVICES <br />PERMIT - 3200CEDAR STREET <br />EVEREIT. WA 98201 <br />(425)257-8810 <br />PERMIT NUMBER 111501,092 DAB" <br />'JOB ALORESS 1612 MCDOUGALL AVE IpON. DESCR. <br />DESCKIPHON INS]'ALI, BACKWATER VALVE 0008233502700 <br />OWNER KEMPF SAMANTHA TYNANT <br />1612 MCDOUGAL CONTRACTOR AMERICAN SEPTIC 6c SIDE SWR LLC <br />EVERETT WA 98201 2606 LARLIN DR <br />EVERETT WA 98203 <br />PHONE 2532239915 PHOW 4257897296 <br />WATER SERCICF. <br />NOTE- A water backflow prevention and/or consullmiml is required regarding cross'conneclioh control for irrigation Scrvires ,..Id <br />services I" or larger. Call Tim Markham at (425) 257-8833. <br />PLEASE CALL (425) 257-8862TWO TO THREE WEEKS PRIOR TO WANTING WATER SERVICE INSTALLED. <br />r, r, <br />SEWER PERMIT NO S11-15525 PERMIT INPP A13ER/0 ION LIIIND. C %� in <br />r—. <br />REMARKS- Please Nnte: The City it relpnnsible for etru:tural defects in the side seacr on the City ROW aide per EMC 14.09.260 m �o <br />INSPECTED 01" ���` I PATE �^ (j-�]'.1r Z= I <br />:.10-1,.. (4751257•RRI O 24 hour, in advance to schedule an inspection. <br />II is the applicant's responsibility to insure adequate protection against sewer backnow if the suvcturc is located in the combined sanitary/slor�ftEd,eT�' <br />systunl. <br />Sewer Utility Poe. 30.00 <br />TOTALFM S30.00 <br />Permits capite if work is not commenced within 180 days of ceases for more than INU days. <br />PTRMIT'NUMBER U1501-082 <br />APPlica tCoPy <br />I <br />