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UTILITIE S <br />PERMIT <br />PERMIT NUMBER U1605-009 <br />Jos aDD�ss 1015 LOMBARD AVE <br />DEsc�zrnTiorr SIDE SEWER REPAIR & BACKWATER VALVE <br />owrrER EVANS KRISTINE <br />1015 LOMBARD AVE <br />EVERETT WA 98201 <br />PxorrE 4253672116 <br />CITY OF EVERETT <br />PERMIT SERVICES <br />3200 CEDAR STREET <br />EVERETT, WA 98201 <br />(425) 257-8810 <br />I DATE: � _ c ,_� r. <br />7 C7 <br />LEGAL DESCRIPTION SEC 17 TWP 29 RGE OS <br />APN: 29OS1%0O2O4SOO <br />TENANT <br />coNTRacTox MARYSVILLE PLUMBING <br />13318 SR 530 NE <br />ARLINGTON WA 98223 <br />� I PHONG 3604355555 � <br />WATER SERVICE <br />SERVICESIZE SERVICETYPE FRONTAGE NO.OFUNITS SERVICEORDERNO. APPLICATIONNO. <br />�.Q� � <br />SEIiER INSTALLATION DATE <br />RF. <br />METER ISTALLATION DATE gy <br />W ATER ON _ OFF _ LOCKED OUT BY <br />REMAAKS: <br />PERMIT NO. <br />REMARKS: <br />INSPECTED BY: <br />NIBACKFLOW DEVICE SERIALNO. <br />#2 BACKFLOW DEVICE SERIAL NO. <br />MODEL NO. <br />-'r: j-�o-:p <br />a3 ��t'.�5a') <br />TSG ,_.. � �. <br />,� � . <br />-�-{ h7 <br />� .� t_.._ r�� � <br />�:. :�=�- �.� <br />� i'�7 <br />�:9 ::C7 j_..� <br />SEWER SERVICE <br />PERMIT TYPE REPAI R I L1D NO. <br />Please Note: The City is responsible For structural defects in the side sewer on the City ROW side per EMC 1 <br />Sewer Utility Fee <br />TOTAL FEES <br />$30.00 <br />$30.00 <br />DATE; <br />TO <br />ppSTIt�G ������ _"" <br />PERMIT NUMBER U1605-009 <br />ADDRESS COPY <br />