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UTILITIE S <br />PERMIT <br />PERMIT NUMBER U1604-040 <br />JOB ADDRESS 2517 RAINIER AVE <br />DEscx�rTiorr INSTALL BACKWATER VALVE <br />owrrEx JACKSON TOD M& DEBRA L <br />385 FARRELLY DR <br />SAN LEANDRO CA 94577 <br />Pxortc 5109182394 <br />CITY OF EVERETT <br />PERMIT SERVICES <br />3200 CEDAR STREET <br />EVERETT, WA 98201 <br />(425) 257-8810 <br />DATE: ,_ � � ,. t� , <br />� <br />LEGnLDEscxlPTiorr RUCKERS 3RD PLAT BLK 569 D-0( <br />�N 00562656900800 <br />TENANT <br />coNTRncTox AMERICAN SEPTIC & SIDE SWR LLC <br />2606 LARLIN DR <br />EVERETT WA 98203 <br />I � PtioNE 4257897296 � <br />WATER SERVICE <br />SERVICE SIZE SERVICE TYPE FRON7'AGE I NO. OF O, OO I SERVICE ORDER NO. I APPL[CAT10N NO. <br />SETTER INSTALLATION DATE <br />METER NO. _ <br />RF. NO. <br />METER ISTALLAT[ON DATE By <br />WATER ON _ OFF _ LOCKED OUT BY <br />REMARKS: <br />PERMIT NO. <br />REMARKS: <br />BY <br />I #1 BACKFLOW DEVICE SERIAL NO. <br />N2 BACKFLOW DEVICE SERIAL NO. <br />MODEL NO. <br />SEWER SERVICE <br />"� a'� <br />k�"i i-ri <br />TSG :�"! t., 7 <br />i r� �.�� ti--• � �-�I <br />�t t�'� --i � <br />F. J 1"'"" �'fi� m�9' tl� 7� M rc= <br />-C::. :F2'_ �'. �" �: f.:-';� <br />-.r, r-rr r*, r-n rr A <br />;,--=s ;. � :x� :x* ;��, ti-. <br />SP-16644 PeR""TT'�'� ALTERATION I ''�''�o <br />C'� `� <br />Please Note: The City is responsible for structural defects in the side sewer on the City R�.' �e�,e��.�;�.Q.$.�Q .w,;� <br />-�.�i r_,J c:a +�•y r> �N C> t..•a <br />—i �"5 4....} .�.:w r._..Y -�•`• {,,,^1 +� (-.;? <br />"w��' ,_} n .,,�J a <br />_.t �"5 (='3 'l.•7 nyY Y_.N C"! l'..ri t�.? <br />.. .'a wr' Ca --:] ;: � i�J ,„-a ••.ir ,:: :s <br />�..r. <br />c:,.� :r� <br />.C":i L.1 �,�Y <br />-•••i �''^ -p, <br />.� <br />IINSPECTED BY: . I DATE: 7`"` ""' <br />FEES <br />Sewer Utility Fee <br />TOTAL FEES <br />$30.00 <br />$30.00 <br />PERMIT NUMBER U1604-040 <br />TO POSTING � � � � � � �DRESS �oPY <br />