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CITY OF EVERETT <br />UTILIITIES <br />PERMIT <br />FERMIT SERVICES <br />3200 CEDAR STREET <br />EVERETT, WA 98201 <br />(425)257.8810 <br />PERMITNUMBEIR U1504.040 <br />DATE. 4/8/2015 <br />JORADDRESS 1921 MCDOUGALL AVE <br />LEGAL DESCRIPTION <br />DESCRIPTION INSI'ALL BACKWATER VALVE: <br />APN 00438438501100 <br />OWNER MOLLENBECK GEORGE F JK <br />Te"nN� <br />CONTRACTOR AMERICAN SEPTIC R SIDE SWR LLC <br />1921 MCDOUGALL AVVE <br />EVERETT WA 98201 <br />2606 LARLIN DR <br />EVERETT WA 98203 <br />PHONE <br />PHUst 4257897296 <br />SERVICE Stu <br />SETTER INSTALLATION DATE <br />METER W <br />\VA7'ER SERVICE: <br />SERVICE TYPE I IRIITLL <br />METER WTALLATION UAW OY <br />WATERON_ OFT_ LOCREDOVr__ RV <br />REAIARAS: <br />NO Or OBITS <br />0.00 <br />RI DA[RROW DEVICE SERIAL W <br />M RAMPLOW DEVICE SERIAL NO _ <br />MODEL NO <br />SEWER SERVICE <br />TSG <br />SLRVICC CM NO I APPLICATIO'I �J <br />PERMIT ND S11-15886 PE0.1Ir Tl PG <br />LID No <br />REMARKS: Please NowThe City is responsible fur struclurol defects in the side sewer on the City ROW side per LNIC 14.08.260 <br />INSPTCT1 DIV <br />t V <br />FEES <br />SCNSI NIIIIIA' IV SID 00 <br />IL <br />I APR 0 8 2015 <br />Y 0'' . 'PP <br />'1'0'I'AL FEES S30.00 '�crn:i.:.. iim, <br />PERMIT NUMBFR U1504-040 <br />PUBLIC WORKS COPY <br />