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4 UTILITIES CITY OF EVERETT
<br /> PERMIT` SSFRVICES
<br /> PE lT
<br /> F m 3200 CEDAR STREET
<br /> EU) RE1 1,V 98201
<br /> r 425725?,n8"8f03
<br /> HERMIT NUMBER U1902 007 Dnp � .'
<br /> JOB.ADDRESS
<br /> - 19i9�VERETTAVE ,; ,r,EGAr,DEseR�TroN
<br /> DESCRIPTION SIDE:SEWER REPAIR �N • 0043916090800,'..
<br /> OWNER ' AHMADNIA HOSSEII�L TT
<br /> SS AUTOMOTIVI✓
<br /> 10018 N"--2":.440T1.,..-:,-...--.!,-..-'."
<br /> 16TII PL CONTRACTOR y
<br /> BELLEVUE WA 9800 OWNER
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<br /> -PHONES
<br /> = <.. PHONE_
<br /> \'UA3'ER�RVICE�
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<br /> SERVICE SIZE SERVICE TYPE FRONTAGE NO OF UNITS SER1ICE ORDER 1SQ APPLICATION NO
<br /> 000
<br /> SETTER INSTALLATION D FE° -
<br />� BY £ s r �.�:
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<br /> METER N`O - - CI7F s #1 BACKFLOW DEVICE=SER1AI O-
<br /> R:F NO #2 BA,CKFIAWDEVICESERIALNO
<br /> z -MODEL NO:
<br /> 'METER ISTALLATION DATE BY.• = - _
<br /> WATERON_ OFF_-LOCKED OUT ABY TSG . m �,
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<br /> REMARKS - - - �` ---i
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<br /> 'SEWER SERVICE . a 4
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<br /> PERMLT"NO _ PERMIT'TYPB -LID NO .l
<br /> REPAIR .k. I
<br /> REhIARTease Note The City is responsible for structural defects in the side sewer on the.City ROW side"per EMC 14 `err
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<br /> SIDE SEWER REPAIR ,`,
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<br /> �- INSPECTED BY - :DATE -_
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<br /> �':a I 'm Z b Y•
<br /> �� FEES ��
<br /> SEWER UTILITY FEE $3090 _
<br /> "E,
<br /> IOTA FEES" $30 00
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<br /> 1�ERIVIITNUMBER U1902 007
<br /> ADDRESS COPY
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