Laserfiche WebLink
City of Tukwila My WebLink |HelpSearch Tips |About |Sign Out
t:.1rL -iiVL ()O1 to' LJICj I -malt <br />Control CITY OF TUKWILA Issued Date <br />6200 Southcenter Blvd. <br />Permit #I,1) ti r 24 3 ,5S' Tukwila, WA 98188 Expiration Date I /1 <br />WATF4 METER PERMIT (PERMANENT) <br />GvNven,S 1 i,, 1 M 0 9 7 6 i" 124 <br />1k <br />SITE ADDRESS 13 9. 14- 5 Ave S'a (Le Vots) NAME OF PROJECT <br />NAME OF OWNER /r2 G.eteA/ 1 PHONE <br />ADDRESS 134 )-4 S.3 5 ZIP <br />NAME OF CONTRACTOR C,_,_, 7 lzwu_r -a- /fit r -.4.C P HONE4�Z- /sho %tia -9S4"a <br />ADDRESS (02 ,60 -o 4 c,-*� r, L, ,r. ZIP L)� <br />wcr4 64)1 -C&J it 7 1. ?o <br />Number of Meter(s) I Size of Meter(s) ['3J4" Q 1" Q 1#" 2" [I 3" Q 4" <br />sg <br />Type of Installation [a/ Residence Apartment No Units <br />[l Industrial /Commerce Sq Ft <br />Fees Regular Connection (401/386 520) Date Paid <br />Installation Fee (401/386 520) Received by Receipt <br />Special Assessment <br />Slc LJL2? Ta <br />Approved <br />PflT lip R F,aser; +Senior Engineer <br />Inspector Use Only <br />Total Deposit <br />(401/388 100) #04 <br />Paid Full Amount <br />cooNick- <br />A-POL0,v__, Installment Agreement <br />(must be attached) <br />Z.— 403 xx <br />Date Paid <br />Received by Receipt <br />I understand that the charge for this installation is based on the actual cost of material <br />plus labor and connection char,8 a including 17% overhead I agree to pay the installation <br />deposit in the amount of !I4/4 on the signing of this application and the balance of <br />the cost when billed (overpayment will be refunded) <br />Water line to the building must be inspected by the Water Dept David Gracie, (433- 1860). <br />APPLICANT'S SIGNATURE Q,�,,_K_I2_Th <br />TITLE J K 'V 14 12„ <br />7 <br />cc Applicant <br />Inspector <br />Finance Department <br />Building Official <br />I hereby certify that the permit holder whose name and address appears on this record has <br />satisfactorily met the standards and conditions for the project approved herein <br />Field Inspection Date City Inspecto 4 Work Order <br />This permit was not signed -off because <br />Initials Date <br />