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L LITIES C#Y OF EVERETT <br /> PERMIT SERVICES <br /> En PERMIT 3200 CEDAR STREET <br /> EVERETT,WA 98201 <br /> (425)257-8810 <br /> PERMIT NUMBER U1602-053 DATE. ZZ— <br /> JOB ADDRESS 2128 100TH ST SE LEGAL DESCRIPTION <br /> DESCRIPTION HOOK UP EXTG HOUSE TO SEWER APN 28052000204200 <br /> OWNER DUBA TERRELL TENANT <br /> 2128 100TH ST SE CONTRACTOR <br /> EVERETT WA 98208-3835 <br /> PHONE 4252327729 <br /> PI IONF. <br /> WATER SERVICE <br /> SERVICE SIZE SERVICE TYPE FRONTAGE NO,OF UNITS I SERVICE ORDER NO. I APPLICATION NO. <br /> 0.00 <br /> SETTER INSTALLATION DATE BY <br /> METER NO. SIZE I MI BACKFLOW DEVICE SERIAL NO. <br /> R NO. 02 BACKFLOW DEVICE SERIAL NO. <br /> BRAND MODEL NO. <br /> METER ISTALLATION DATE BY <br /> WATER ON_ OFF LOCKED OUT BY 'I'$Cj <br /> REMARKS: yy ICC] _ <br /> I�r <br /> SEWER SERVICE �> , <br /> .I <br /> PERMIT NO PERMITTYPE NEW CONNECTION LID NO. 4:11 H-�•• <br /> t•. <br /> REMARKS: Please Note:The City is responsible for structural defects in the side sewer on the City ROW side per EMC 14.08.240,) <br /> HOOK UP EXISTING HOUSE TO SEWER. <br /> NO SYSTEM DEV FEE DUE. � r ;? <br /> INSPECTED BV. DATE: <br /> FEES <br /> Sewer Utility Fee $30.00 <br /> TO POW-SPING S-I S KP <br /> TOTAL FEES $30.00 <br /> PERMIT NUMBER U1602-053 <br /> ADDRESS COPY <br />