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mai ILITIES <br /> STY OF EVERETT <br /> EVERETT PERMIT SERVICES <br /> WASHINOTON PERMIT <br /> 3200 CEDAR STREET <br /> EVERETT,WA 98201 <br /> (425)257-8810 <br /> PERMIT NUMBER U2203-019 DATE <br /> JOB ADDRESS 620 10TH ST LEGAL DESCRIPTION <br /> DESCRIPTION SEWER ALTERATION&BACKFLOW PREVENTION(DCVA) APN: 29051800203900 <br /> OWNER EVERETT PORT OF TENANT JETTY LANDING RESTROOM REPLA( <br /> PO BOX 538 CONTRACTOR FORMA CONSTRUCTION COMPANY <br /> EVERETT WA 98206 PO BOX 11489 <br /> OLYMPIA WA 98508 <br /> PHONE <br /> PHONE 3607545788 <br /> WATER SERVICE <br /> SERVICE SIZE 1 SERVICE TYPE 1 FRONTAGE NO.OF UNITS SERVICE ORDER NO APPLICATION NO <br /> 0.00 <br /> SETTER INSTALLATION DATE BY <br /> METER NO. SIZE #1 BACKFLOW DEVICE SERIAL NO. N <br /> R.F.NO. N2 BACKFLOW DEVICE SERIAL NO. <br /> BRAND MODEL NO. <br /> METER ISTALLATION DAT$ BY <br /> WATER ON OFF_ LOCKED OUT BY TSG <br /> DCVA BACKFLOW PREVENTION <br /> REMARKS: <br /> SEWER SERVICE <br /> NaPERmrr SP-18784 PERmff TYPE SIDE SEWER-ALTE I LID NO <br /> REMARKS: Please Note:The City is responsible for structural defects in the side sewer on the City ROW side per EMC 14.08.260 <br /> INSPECTED BY: I DATE <br /> IFEES � ) I <br /> V <br /> PLUMBING FEES $35.00 <br /> \5 (b\\SEWER UTILITY FEE $30.00 ^ fp <br /> TOTAL FEES $65.00 wow ply+ of tv-tiAbre <br /> 1 PERMIT NUMBER U2203-019 <br /> ADDRESS COPY <br />