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� <br />� <br />� <br />UTILITIES <br />PERMIT <br />PERMIT Ni1MBER iJ1601-012 <br />!OB ADDRESS 37 ] 6 ROCKEEFI.L,ER AVE <br />p�SCRIPTION INSTALL BACKWATEn VALVE <br />OWNER <br />�i;or�� <br />ARNOLD MARTLYN <br />371 G ROCI<EFELLER AV�, <br />�V �;R�,�T W A 9820 1-493 1 <br />4255685393 <br />CITY OF EVERETT <br />PERMIT SERVICES <br />32�0 GET�AR STREE'i' <br />EVERF.Ti', WA 98201 <br />{425) 257-8810 <br />DATE: <br />i.Fcnt. o�scR: EVERETT DIV M PLAT UF BLK 922 D-0 <br />APN: 004381922025Q0 <br />� eNnNr <br />coNi��— <br />AMF;RICAN SEPTIC & SIDI: 5WR LLC <br />2606 LAili.IN DR <br />EVLRETT' WA 98203 <br />i�iic;r�r 425789729b <br />wA���x s��vicc <br />SL•RVICF.URULRNO. <br />FItONTACiL• <br />CtO.OP UNI'f5 <br />REMAAKS' <br />NOTL: A�water hackElow prevention and/or con�uaja425 �25798833. �eg��ding cross connection control for irrigalion services and <br />serv�ces 1" or la+ger. Ca1i Tim Niarkhar { ) <br />PLL;ASE CALL (42S) 2�7-8g62 TW4 i0 THiZ�E WEEKS PR10R TO WANTWG WAT�R SF,RVICE INS'SALI.BD. <br />� <br />. 1.1Q NO. C== <br />SGWGR PERMIT tJU. SP-I 6'��3 PGRMIT l'YPF. /1L�C h RATIO�} <br />RIiMARKS PleaSe Note: i�be Ci1'S' �S r�SPUnsihle for strt�clurnl defetts in the sidc se�ver nn Ihe City RO��' s�dc Per �-�':L �'�•�}8.2G0 <br />NO. <br />lNSYEC'1'Gll BY: "�,,�;r'�,.-"• j,�'a-�P-" '°" �,� �+�� <.� c: <br />�:=a � r�+ '_s -_.,v <br />NotiFy the PubSic Works inspector (4 <br />257-8810 24 hours in advance to schedule an inspection. �, �, i_� <br />_� a <br />It is the appiicant's responsibilit}� to insure adequate profection against s��ver hackflo�v il'the structuse is located in the combined sanitarylstoi`PS�S`-�.4 <br />system. _ _ <br />Sewer Utility Fee <br />3�.U0 <br />TOTAL'FEES $30.00 <br />Persnits expire if work is not cammenced within 1 SO days or ceases for more than 180 days. , <br />PERMIT Ni1MBER U16D1-0]2 <br />n�,P+��a�u coNy <br />