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UTILITIES CITY OF EVERETT <br /> PERMIT SERVICES <br /> PERMIT <br /> 3200 CEDAR STREET <br /> EVERETT, WA 98201 <br /> (425)257-8810 <br /> PERMIT NUMBER U1704-014 DATE: <br /> JOB ADDRESS 1901 M KILTEO BLVD LEGAL DESCRIPTION <br /> DESCRIPTION SIDE SEWER REPAIR APN: 00417100004101 <br /> OWNER SCRIVEN LIVING TRUST TENANT <br /> 3208 LAMESA PL CONTRACTOR C K EXCAVATING INC <br /> FORT WORTH TX 76109 18634 SE 128TH ST <br /> RENTON WA 98059 <br /> PHONE <br /> PHONE 4252556994 <br /> WATER SERVICE <br /> SERVICE SIZE I SERVICE TYPE FRONTAGE NO.OF UNITS SERVICE ORDER NO. APPLICATION NO. <br /> 0.00 <br /> SETTER INSTALLATION DATE BY <br /> METER NO. SIZE 11 BACKFLOW DEVICE SERIAL NO. <br /> RF.NO. #2 BACKFLOW DEVICE SERIAL NO. <br /> BRAND MODEL NO. <br /> METER ISTALLATION DATE BY <br /> WATERON OFF_ LOCKEDOUT BY TSG <br /> REMARKS: <br /> SEWER SERVICE <br /> PERMIT NO. SP-17186 PERMIT TYPE REPAIR LID NO. <br /> REMARKS: Please Note:The City is responsible for structural defects in the side sewer on the City ROW side per EMC 14.08.260 <br /> INSPECTEDBY I DATE: <br /> FEES <br /> SEWER UTILITY FEE $30.00ildb� <br /> C17-1/or <br /> perr;I it 47c-!. <br /> `es <br /> TOTAL FEES $30.00 <br /> PERMIT NUMBER U1704-014 <br /> ADDRESS COPY <br />