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UTILITIES <br />PERMIT <br />PFRMIT NUMBF,R U1601-012 <br />Jox nnn�zr.-,ss 3716 ROCKEFELLER AVE <br />[�sscR�PT��oN INS'TALL BACKWATER VALVE <br />owN�R ARNOLD MARILYN <br />3716 ROCKFFELLER AVE <br />EVERI;TT WA 98201-4y31 <br />����Nr 4255085393 <br />CITY OF EVERETT <br />PERMIT SERVICES <br />32Q0 CEDAR STREET <br />EVERETT, WA 48201 <br />(425) 257-8810 <br />' nATE: <br />�FCA� nescau����oN EVERETT DIV M PLAT OF BLK 92: <br />Ai'N: 0043 8 l 92202500 <br />fG:NAN'I' <br />coNTaAcroR AMERICAN SEPTIC & SIDE SWR LI,C <br />2606 LARLIN DR <br />�VERF.;TT WA 98203 <br />I � i�iic�Nr�: 4257897296 � <br />WATN;N SERVICF, <br />SI�RVICE 517.E SF.RVICE'PYPH FRONTA(�F: NO. UI' UNIl'S I SGRVICIi C)ItUER NO. I APPUCA�PION NO. <br />I <br />I � �.�� <br />SE7TERfNS'PALLATION DATF <br />ME'iER NO. <br />R.F. NO. <br />ME"1'tR ISTALI.ATION DATE 8Y. <br />WATERON_ OFF'_ I,OCKEDOUT BY <br />IiEMARKS: <br />BY <br />i!1 BACKFLUN DEVICE SF.RIALNO. <br />k2 BACKFLOW DEVICE SERIAL NO. <br />MODEL NO. <br />SEWk:R SERVICE <br />'TT "7;1 <br />TSG -J�.x-� i �tl c�'s <br />r-'� � ,�i�, <br />�,,,�� � „ <br />� .� I�` { !TI <br />=I,`.« :� C":�� <br />:"� I +'i <br />i'7 ;T9 j...-. <br />��:�<M�,No SP-16483 v�'�M�� "���� ALTE�RA"I'ION I �.��,No �� <br />r� �_ <br />REMARKS: Please Note: The City is responsible fcir structural def'ects in the sidc sewcr on the Cily ROW side per [:MC 14.08.� <br />+�,. � -u>. <br />�,� r_�� <br />�'_'�a.s <br />'::o �g ..^ :� <br />.�Y C;"��,T <br />INSPECTED BY�, <br />Sewer Utility I�ee <br />'1'OTAL FEES <br />FEES <br />$30.00 <br />�30.00 <br />UATE: <br />t <br />e�� <br />•.�n: <br />C;� �wy �""� <br />--� r•.:i ���� <br />a'• <br />1:.1"7 <br />�M. �..:7 <br />PERMIT NUMBER U1601-012 <br />TOPaST�NG �'� � %i �, <br />���►�Fss ��oNY <br />