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CITY OF EVERETT <br />UTILITIES <br />PERMIT <br />PERMIT SERVICES <br />3200 CEDAR STREET <br />EVERETT, WA 98201 <br />(425) 257-8810 <br />PERMIT NUMBER U1603-045 1 <br />DATE: 19-a S — ( IV <br />JOB ADDRESS 1517 BROADWAY <br />LEGAL DESCRIPTION REMINGTONS 1 ST ADD BLK 316 I <br />DESCRIPTION INSTALL BACKWATER VALVE <br />APN: 00553631600300 <br />OWNER HENDERSON KIM <br />TENANT <br />PO BOX 13117 <br />CONTRACTOR AGOSTINO CONSTRUCTION INC <br />EVERETT WA 98206 <br />23418 SE 247TH CT <br />MAPLE VALLEY WA 98038 <br />PHONE <br />PHONE 4254338281 <br />WATER SERVICE <br />SERVICE SIZE SERVICE TYPE FRONTAGE NO. OF UNITS I SERVICE ORDER NO. I APPLICATION NO. <br />I I <br />I 0.00 <br />SETTER INSTALLATION DATE BY <br />METER NO. SIZE #i BACKFLOW DEVICE SERIAL NO. <br />R.F. NO. I #2 BACKFLOW DEVICE SERIAL NO. <br />BRAND MODEL NO. <br />METER ISTALLATION DATE BY <br />WATER ON__ OFF_ LOCKED OUT__ BY TSG <br />REMARKS: <br />SEWER SERVICE <br />I <br />PERMIT NO. SP-16582 PERMITTYPE ALTERATION 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 />FEES <br />Sewer Utility Fee $30.00 c <br />'0U <br />MAR 2 8 2m <br />CITY OF EVERETT <br />TOTAL FEES $30.00 Perrmt Services <br />PERMIT NUMBER <br />U1603-045 <br />TO POSTING <br />--�/17' <br />••• �+•� <br />ADDRESS COPY <br />