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<br /> rt UTILITIES CITY OF EERETT
<br /> ,% PERMIT SERVICES
<br /> & PERMIT.
<br /> 3200 CI DAR STREET
<br /> RETT,`WA 98201 -
<br /> EVE.,
<br /> (425)2-57-8810 .:
<br /> f1 7 n9
<br /> PERMIT.NUIVIBER ,..„,•:,U1810=013 DATr O a7 C,I . .. 01�
<br /> JOB ADDRESS 3422 BO"T - LEGAL DESCRIPTION
<br /> DESCRIPTION INSTALL BACKWATER,VALVE APN. 00436982402000
<br /> OWNER HENDRICKS KAREN TENANT
<br /> 3422 HOYT AyE CONTRACTOR AA;PLUMBTNG LLC
<br /> EVERETT WA 98201 8611 VISTARAMAAVE
<br />_ PHONE':
<br /> EVERE PT' ?VA" 98208
<br /> PHO
<br /> �` 4254890123 `. -
<br /> WATER SERVICE: ii
<br /> SERVICE SIZE SERVICE TYPE FRONTAGE NO OF UNITS - - SERVICE ORDER NQ' APPUCATIO?LNQ
<br /> 000
<br /> SETIER INSTALL'eATTON DATE- BY- - - - -
<br /> ;.METER NO' - SIZE : #1 BACKFLOW DEVICE�SERIAL.NO. -
<br /> RI'NO - ':112 EACKPLOW DEVICE SERIALNO. - - _ -
<br /> BRAND MODEL.NO`
<br /> 'METER ISTALLATION DATE EY.'. ,,, .r.�
<br /> WATER ON_:OFF_-_LOCKED OUT,. -BY - _
<br /> REMARKS`. `.:. -.
<br /> SEWER SERVICE
<br />,::;:i,: ,-PERMITNO. SP-17851 PERMIT TYPE• ALTERATION LID NO
<br /> ;.:1-.
<br />''' '''''.'"1%' .--
<br /> EMPlease Note.The City is responsible forrstructural defects in the side 's;„' :....-„,',1,1-
<br /> eon the City ROW side,per EMC 14:08 260
<br /> .,:i:,.s.'.,' ;-.,--', !,:-i...,',::::,,:'.:-::,..,:-::,,:„.:!:-.:.: .,'"::::.'.:,,,,-ii:,:.----.,:',.-:,:,,
<br /> INSTALL BACKWATER VALVE
<br /> INSPECTED BY DATE - - - r
<br /> I"
<br /> � r
<br /> , -
<br /> FEES
<br /> I
<br /> SEWER UTILITY FEE •$30.00
<br /> '. 00T---r-..-0-9::-'ii--201U
<br /> TOTAI,FEES'" $30,00 CITY OF EVERETT
<br /> rvjre6
<br /> PERMIT NUMBER -.V,,,,,),0
<br /> ADDRESS COPY.
<br />
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