2424_001.pdfCITY OF EDMONDS
1215THAVENUENORTH- EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED ENG20190379
WATER METER RECORD
Permk Number: ENG20190379
Job Address.-2123I 92NDPLW,L:l)ilvl0NDS
SELECT HOMES INC
9215 BOWDOIN WAY 16531 13TH AVE W SUITE A107
EDMONDS, WA 98020 LYNNWOOD, WA 98036-
(206) 963-3787
LICENSE #: SELECHI 110 KN EXP: 01/02/2021
JOB D LSCRIPTION
DESCRIPTION OF WORK:
Water meter for new SFR (demoed e)dsting SFR).
MIETER SUE: V
Y NEW SERVICE FROM CITY MA IN TO PROPERTY LINE fNSTALLATIONFEE: $2,970.00
Y A SPRA LT/CONCRETE CUT CONNECTION FEE: $0.00
Y- FINAL PATCH BY CONTRA CTOR STREET CUT DEPOSIT: $0.00
OWNERNAME:
BILLINGADDRESS:
Y SFR N IRRIGATION FN] APARTMENT / CONDO - UNITS: 0
N DUPLEX N FIRE CONNECTION FN--] MIXED USE -COMMERCIAL FLOORS: 0
N TRIPLEX N OTHER: RESIDENTIAL UNITS: 0
N— COMBO FIRE/DOMESTIC BA CKFLOW ASSEMBLY REQUIRED
PUBLICNVORICS INSTALLA,rioN-irriLIT)IBILLIN(.
N I LOCKED I N I UNLOCKED PROJECT NUMBER:
METERNUMBER: LOCATE REQUEST #:
STYLE: DATE CALLED:
METER READINGr AND
MANUFACTUREWS#: REGISTER #:
METER LOCATION:
SERVICE MATERIAL: PRESSURE: 0 GPM: 0
DATEOFWORK: WORK BY:
REMARKS:
*A17ACH DRAWING WHEN NECESSARY*
U/BACCOUNT: ROUTE:
READ AFTER ADDRESS: WATER SUPPLIER:
ISSUED
TYPE OF REPAIR
= Asphalt Roadway/Walkway
= Concrete Sidewalk
= Concrete Curb
AREA REPAMM
( Ft X Ft ) = Sq. Yds
( Ft X Ft ) = Sq. Yds
( Ft X Ft)= Sq. Yds
( Ft X Ft ) = Sq. Yds
( Ft X Ft) = Sq. Yds
( Ft X Ft ) = Sq. Yds
Lineal Ft
Lineal Ft
Lineal Ft
Total Repair Costs:
Less Street Cut Deposit:
Invoice/Refund:
ENG20190379
IHTAMCOST
$0.00