ENG20130393.PDFof 6 DMo�O
CITY OF EDMONDS
-' 121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED ENG20130393
Permit Number: ENG20130393
Job Address: 15500 75TH PL W, EDMONDS
3528 102ND PL SE
EVERETT, WA 98208
DESCRIPTION OF WORK:
NEW SFR DRIVEWAY, UTILITY CONNECTIONS
ROGER OLIN CONSTRUCTION
PO BOX 3216
EVERETT, WA 98203
(425)337-7622
LICENSE #: ROGER00088CN EXP: 02/28/2014
METER SIZE: 5/8" + 3/4"
Y NEW SERVICE FROM CITY MAIN TO PROPERTY LINE
Y ASPHALT/CONCRETE CUT
N FINAL PATCH BY CONTRACTOR
OWNER NAME: George & Ginger Olson
BILLING ADDRESS: 3528 102nd PI SE Everett, WA 98208
INSTALLATION FEE: $550.00
CONNECTION FEE: $4,014.50
STREET CUT DEPOSIT: $115.00
Y SFR N IRRIGATION Ne APARTMENT / CONDO - UNITS: 0
N DUPLEX N FIRE CONNECTION N MIXED USE -COMMERCIAL FLOORS: 0
N TRIPLEX N OTHER: RESIDENTIAL UNITS: 0
N COMBO FIRE/DOMESTIC BACKFLOW ASSEMBLY REQUIRED
N LOCKED I Y I UNLOCKED PROJECT NUMBER:
METER NUMBER: LOCATE REQUEST #:
STYLE: DATE CALLED:
METER READING: AND
MANUFACTURER'S #: REGISTER #:
METER LOCATION:
SERVICE MATERIAL: PRESSURE: 0 GPM: 0
DATE OF WORK: WORK BY:
REMARKS:
***ATTACH DRAWING WHEN NECESSARY***
U/B ACCOUNT: ROUTE:
READ AFTER ADDRESS: WATER SUPPLIER:
N41
01
ISSUED
TYPE OF REPAIR
F7N Asphalt Roadway/Walkway
Concrete Sidewalk
FN Concrete Curb
AREA REPAIRED
( 0 Ft X 0 Ft ) = 0 Sq. Yds
( 0 Ft X 0 Ft ) = 0 Sq. Yds
(0Ft X OFt)=0Sq. Yds
( 0 Ft X 0 Ft ) = 0 Sq. Yds
(0Ft X 0Ft)=0Sq. Yds
(0Ft X 0Ft)=0Sq. Yds
0 Lineal Ft
0 Lineal Ft
0 Lineal Ft
Total Repair Costs:
Less Street Cut Deposit:
Invoice/Refund:
ENG20130393
REPAIR COST
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$115.00
$0.00