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HomeMy WebLinkAboutWTR2702104 W-2104 Interlake Christian Church (DDCVA & 2 Ea. Water. Meters) 1 �� � � b�� �lti'"`r•Tr t �� � i � r t • ti i v <a� i 1 W-2104 WTR - 27 - V104 WON87031 Interlake Christian Church 4300 Jones Ruo ME NntaN OOCUR 6 Two Watermeters t t� ORDERSFOR WATER SERVICE INSTALLATION NO 3142 WM orEY Nos Aod a l Meter Cl f//Q7. DO su sale No. Sesto Cr^dY M CRY Yeltz NOD On Saw« Y„X[No ❑ Down Peymem Walter Us.": C]Rara«rer Dom..uO�QI Spacer Ual Colnrastrol CNYpa �comm«or Inn„on laro.C«nara IClty) q [::]Ineo.Mal Fa.same❑ ❑cil sparal aaeessear.Dlaagl �(T. S.waOa Et amps Mat«ElYes 19No T„ip.Nyerand Maw Capoud M.A.,Sra. Rael No. Total F„ Fire Pr«aaim Sar�woya /0� Y„ ®NN. 4&Z.. - • IrratalMUn o : So.A,dr.al 1 3 c,� S..$«VILY Mew M.- Nam.of Commaraal Pmect��'P e/L �i�I CrJA jY CbtAMH Mat«No. _ Lapr Gsagaon G Afladra0 « IAd.tnat.ItaO _ Comment. ❑5„Ra I s 1 T.A IFI No. $grNIW. 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O Y„.Ayr.Ynond No. In F..Of cN.rpa s Spear UeaN Comactlon chow If y„.spoor UOty Cmn.rmr Cape oaaae On ❑Y„❑NO ❑PO PrwgVII apu«a FI. _MWOPlaa Urw_SmyN F«rry Lots TM IIYgVa✓al�'NwMG'rrwan area.M1war�rw l«a«arynr YanYrw..r wrrnaONrI4Y+warwn YmaY.w�«NfYrr MYnY M«L r11M MMr"rIW lrYria«Y.r.Y arNF rrprnaweyreayy«yrM aaYeYYr.Y1r«rrNYY«wiY WY6hMC.Ir MnrM swnlns.rn..'.eaYIW«eWrr.r.MwnaY«r��{YIPrr4w.pw.�rlYNrlGWIaaOY.W. Slpnall d Owt«or A"M (Cob) Ciry r Randal Aunonzvn Ag.nt Ora) A .N.r. U.ael rrw.errYwnre &Ibry Ouaaema 2352520 Mr«InvAlso n Owsaons 205.2Cas M NVar Me Y CRY OF RENTON WATER UTILRY,200 MILL AVENUE SOUTH,RENTON,WA W55 PHONE 205.2 ' gleyaly.re+r....... _ N .A ..ill t w, DHDER FOR WAITER SERVICE INSTALLATION NO 3198 Zyoo°O ji`��ndry Sal.No. b Lan Sorb S.rwa•Cradn In O Vu® No❑ On Sw.w Va. ON, ❑ Dorm PaYnleaa I W.I.Usage: OR..M.ntlJ DMr.ana® SaaaM UUMY C««aaon Charge ®Comn«wl Irriv.bon 7� Qindwbw Fu 5«.aa0 WCam«a Others) ❑OVA SReaal ANuarn«n Oa1M . i Saway.E..,M Maba❑Yu ®Na T«na Hrr& A M•Wr Dp .j M•W Sla R.owM No. TaalFu i 2y(J7.°O Frs Poobawn SarNt•E)Yu ®No Sb. ImWWlpn. I &a .awneIa su•s.nn,. n_ N..d Commeraal Rolaal YN&IA CHa'2SAau Gt R•YN Mae.Maws---- M«r Nn_ Legal 0.aolptgn 0 Alband or —_ Data IrylalWd Q+ �ommanl•' ❑Sea B«A Tax A—No. 570 Q�$q S Nn S arAeida CBY LknIw i1. ❑ In aaaM`•boMrd«Y ❑ Cl;*Arrlu ❑ R.Weaa hom D.ala ❑ B•uul«y RMaw BO«d Ravand� - ChIaa C«WCEon C•nod R.porad Yu to Atl.AWp %Iao &aaL« «i Dbw CAarA V"Amorwy Dek DCVA ElRra mmaa Va.BruaarI R❑ .dla d Raeutna Bait Flaw DaRoa 0. ._hEH_ 7,F1 PICQlkXT7Gc Adras.: !!°US B(2)457DA7 A&We- IOW) Bw son,ro. lrVTECL:r lax= CHd'23T74 — _&4H UAP[M AEdrau: ![30E3 liswe s d.r Ne- CaNraelon lWaaW) Area B«Wd b, ] Racb Wabr 1 1 SwIW Water 5•.IW Wabr Cod•No. � Tanpra,y SwNn AY+a«awnc Yu No �( S Yu,AvWan «ard wnl Rnv No. SahAne W be IraaM un an E.um.nl Ye• No X If Yu.Eaa«na d Ra...IV Na. 1 IsiT«a An Exbnrq Sna Sanlo.i Yu No M Yu.W.M Rrole Na. W- In Favo:d EA%I%LAI..C° Apaamanxi Y.. No It Y a p.Avr.anwnt CMrp. Spad•I UMlly CorWclbn Clwv N qa,$pgal UtlM1ry Connapian C'urq herd on. ❑Vu❑No ®Po Pa.MaI.N ' V'1 saw.Fl __MrMRM. Nb_ 1 •a+rwaw Ipena+«xra~Wwawaaaraww+aw+Wp.«Wawrwauraa..r Wur.wrb.lr+raw•r.w Fanely lda WaeWjop wrwewar,«.a.r.a«.r..wanwapa.wrWpwwnawv.w W.r.M ♦n.•xWMiya..n awaaN..ara.a aaaup.M.awm.re.«a dxw Aawn Pos,*err Y«.pMafe.w as f. 1 V BgnMtn Of Owar««Av«N (tall) city d R.,non AumonxiW Avant (d.W) raa..rA.aalaw i eaaa..yaa.a Blaay Onalms 235.^52v Meter InaaN.lwn Do••un.ZJ5.2W6 ��Y /j rM•Ylap Mp n��•+/[�C gear waaear CITY OF MENTON WATER UTLITY,2W MILL AVENUE SOUTH,RENTON.WA INIMS RHONE 235 r` f PUBLIC WORKS DEPARTMENT ENGINEERING DIVISION CITY OF RENTON, WASHINGTON C/ APPLICATION ONLY - UNTIL VALIDATED 4NUMBER ET �` owner Locat on of Work - Address/ V 30 d1w tilE / n INSPECTIONS FEES _ C�-/Ll'q(/' CONSTRUCTION Sanitary Sewer/Storm Water Permits Right-of-way Construction — PERMIT Right-of-way Inspection Fees (Public Right-of-way) Water Inspection/Approval Fee /33B• 8� Special Utility Connection Fee, Water 7z77CP-ZI Water Latecomer Fee —' Special Assessment District, Water Date Issued Sewer Inspection/Approval Fees t - IS- q'f Special Utility Connection Fee, Sewer Expiration Date Sewer Latecomer Fee c` µ/c Main corll/lter -onser ,D _ Reference Data Special Deposit, Private Latecomer y_ Special Deposit, Cash Bond TOTAL FEE �9 Description of Work I 04- and Number of 2 I Contractor v^I-lC�� / r Business v^�q, �1 W' License STS Address F0 0 1 pB�on „y/Oo0,0 `+Ys ITT IYSUNDERSTOOD THAT THE CITY OfV RENTON SHALL BE HELD HARMI.ESS OF ANY AND ALL LIABILITY, DAMAGE OR INJURY ARISING FROM THE PERFORMANCE OF SAID WORK. ANY WORK PERFORMED WITHIN THE RIGHT-OF-WAY OR ON SEWER MAIN MUST BE DONE BY A LICENSED. BONDED CONTRACTOR. LOCATE UTILITIES BEFORE EXCAVATING. L 235-2631 FOR INSPECTION. 11 between 8 AM and 9 AM for APPLICANT 'napection in afternoon, call fore 12 Moon the day before or inspection in morning, PUBLIC WORKS DIRECTOR SPECIFY TIME FOR INSPECTION. t-ALL 215-2620 for street signs CALL BEFORE YOU DIG By GO nd lighting. 48-MOUR LOCATORS 1-800-424-5555 o i' t e ORDER FOR WATER SERVICE. INSTALLATION NO 3374 WOM lWu No Aop A 5 teals Coss. Sundry saw No. _ In City �InauW w San S N«C n l n w v« ^� ® DPaa w.w U." OR«d. pay wn c N-" ;:!Z CmoM Inplro 4 Fv.S. s1� r r t` D..k1 S.wep.Ea.rrpp M.M®Y« []No Tamp.Hy&w Wes Osp«N M.4rs4.?^t fULt /+tiy n+ 6 fwr Ptf'IrTnl HMJ R.oFd No Total F. { m/ai n Fn.Prol.Nm$oW`o.]]©Jvp ❑No S.. InuMl.Aon S.m«Abr.« 'f%Q8- TrjNfS AVt N� S.a S.amm " M N.m.d C aFsr Mae. -- Rala4lw�tQlAar C\RI TIAJ CNNR(N — Male, Na. LK.,D..4�n ❑ Atlad4d a DaN InaMI�W I w•4104 ------- 1 Comm«la ❑S«Beck P.Y7A a 1,1 lAurY ( lfhq' L N. &.to T«Aaaa4NN.. '�39570 0059 n ou4M.CNy UmN.. ❑ In sarMw p.Wny ❑ Cov«rN b Amu Bahasa from DsF ❑ Bounduy R.sl.w Board RpurW Qws CaNruEon Corprtl RapFad Yp DouM.CIwA VolvoA".mdy DalsalFr DCVA AonppNsrlo Vac Br«kr❑ Praaslna Va.Br.aku� R.ducsd Aaa mmo am Flan D.N« Came, FAIN floQf A'TYS Ada..: 1605 9ar�.Ta Flat lykng NA q31 f� M Sate To IPNer4( I0E41A\F ChfISflAtJ CNIrG<q E{ Addr«a SEA `Mt: wA ejal♦ Conlr.dor � CA.n� CAI 1 AVf Nf Ckvn, f IN.41 AM«SFwd.y. Raman W.I.r ® Seat"Wales Seattle WSW Cab No n . Ta wy S.ryA�.AW«nnnl: Y« No d Vp,AWs.m.nl Rsoordrp No. Sam«b bebra4d on N E.«m«I Y«K No n Y«,Eaaan R.coll No, IsMr T .an EzIWrM SNE SwYoe, Y« fb NY" Ws4r Po act No. W- Eaia Lsl!&Ca s A.r..nbnl) Y« No If Yea,Aor..m«I No. n F.vo of ch.,$ sp.d.1 UMNY Conryo.on CMrq If Yea,Sgn.I UhNN ConiwAon C/wpa b.W on:_ pY«pNa ®Pop«a«y F_d209 n+Fa�nYws.urowwp.ay«wra..aa a -Ft. —MulopMa Unl4 r..Warrww«r�..rw.wer� ___SFRM Fundy Lox a�'Na^r..FNbrl MibnY Btl.FwYMM1Y.MM.w..w«.4 Fab _~FaM1aYa Waw«earn wl PY.ngrr elMsn.rb.M Wtr NF.GarrMv.Nw FFnFYanwwbv.nl«abp Mrrrr.FlrrY l.«r~Ti w~a®C.rs'M aMI Wwn C Taa Ma gaP.lYM.t. _ Y�. hhtr✓ seee a Cvrrr or ASry (b4) c of R.M Autlwlanp Ap«t (data) V A wnw-uanr...s rF...Fgr..w. O'WQ OIM.Ipy 2 25M Metter Invall.bn Oa«.ona 2%.2616 f Ilea CITY OF RENTON WATER UTILITY,1M MILL AVENUE SOUTH.RENTON,WA MM PHONE'. nS-MI V TO k mow+^-..- f 1 AUTHORIZATION OF SPECIAL BILLING Is tt DATE PROJECT NAME 7r, �silwE- CM .L_ rh , n PROJECT'NU'bWER; Ile' r WORK ORDER NO. It is the intent of[hit letter to anthorim the Gty of Renton to bill the ondenlgned for all costs iocorred relative to the Wove-referenced project by the City of Renton for the following work T.� d Unl F 'blC� h 1 1 MA�, BILLING TO BE SENT TO; Name IhK nl sew fn. A i e Addrarx City. _ Sv�Ae 1 A QF'iGn Att¢ i - Phone No: _ ar/D open.Contractor or ' o ' Agent 5 1 City of Rento(1Plannin uddingi Public Works Receipt N No 1999 Work Order Received of t•Q,.� _ Date 19 Via. / T_ 000/320.W.00.00 alaMo(wsy 0I/513.90.00.03 Yam wuerivpe awn ('au.rvcoon (IOW) .�.ry� Appg c (4033) 000/313.D WA0 R1aMN-W.r lmpcc0xg (WIC I21r000/31111.IO.00.IO spM UrWry Grnn<clbn gl/3a1.10.00.IS S-Rary scorer (SMI) St.waur (4O69) I01/30-90.00.01 serer ingpc 41411/324.10oOm Strom WMer ParmlM (106t) r3 Appg + Fro (m10) 121/l�.w.ao.30• spccia)UOMY _ 131041.50.00.39 P1u. Mu,,(Tax) (I035) Caa.aug serer (WW) 317/311.W.00.I9 H T--KT-) (W)6) I21/3M.1000.31 spc AmtlrM a DWrecl.serer (WIS) 000/0.SI9.90.1301 P'uaac (70S3) 101/3a/.1000.13. Mlac.Wager liuW)Mbn (I059) 0 d 000/9/1.WA0.00 Map. -PM1Y1'.x) (]OIl) 121/3111110 W,W specl.l As.esncnl Ub01n.W.. (MI6) 000/311.60.0o.0I M�Mlolbn.(1'.a (]Op9) 131/31111.10.0010 SpecW Ut01y 000/341.60.00.34 Mao Copps (7009) fa�necvbn Wager (M36) Z Z/ 01rAI.90.W.o1 Waler liupcavon 000/t31]000.00 Tax (999W Apryo (MST) 1()'MVg0/.3]2.M.00.o( hrtinR Rrmn (Ow)) I(J,A(K).00.369.%.Is W.1..M.xcrcnuc ( 025) i MI/13].00.00.00 5prraWp.'.y1pe..le find (ros/) -ZL-Xw.0p TOTAL Pettivdlq (a�oO�rn_ _ C..w __ cMck 47�_ `+TileCussaner Ye1brFinance Pink 11ow1J 1rrM11gY i i 1 i {t 1� IR Rf 4: �i 4 AUTHORIZATION OF SPECIAL BILLING DATE APAT' » 1o9_V� PROJECT NAME INTERIAKE CHRISTIAN CHURCH PROJECT NUMBER W-1104 _ WORK ORDER NO_ 87031 It is the intent of this letter to authorize the City of Renton to bill the undersigned for all Costs iacurred relative to the above-referenced projert, by the City Of Renton for tht following work f — TIME n MATERIALS FURNISHED BY CITY OF RENTON WATER DEPT. TO PERFORM THE FOLLOWING- CONNECTIONS TO EXISTING WATERMAINS, WATER PURITY SAMIPLES AND RELATED WORK - LESS DEPOSIT 5400 00 PAID UNPERMIT P i 1 i f 1 _ BILLING TO BE SENT TO ' PRINT Name:{!t► 3:N 1 p fl JrCR'rl s Addres= /GQ5 C34, Lsro v qi c U WILL BE BILLED TIME AND MATERIAL R ANY WORR DONE BY CITY STAFF TO City.SYJ47fLL L✓A 9$/Z Z PAIR DAMAGES Attm e«m - Phone No: 32.3 (�C-Grsc eow'/wet M iC t.r6r C'vs 1cr-- AT 3dJ -7Y?'+- ;NIL =;w Cd� ., Owncc/Developer, Contractor or Authorized Agent 1. s �3 t . PROPERTY MANAGEMENT FEE REVIEW O DEVELOPMENT APPLICATION REVIEW SHEET O PLAN REVIEW ROUTING SLIP O ENVIRONMENTAL CHECKLIST REVIEW SHEET Y ,�t/—(b�„"" /�� " � � I APPLICANT: 1444yl- � Oill RECEIVED FROM (date)',3._ JOB ADDRESS: /L O ag, x4 WON , NATURE OF WORK: GREEN — O SPECIAL ASSESSMENTS AND CONNECTION FEES APPLIED NEED MORE INFORMATION: O LEGAL DESCRIPTION O NOT APPROVED FOR APPLICATION OF FEES 7 SQUARE FOOTAGE O VICINITY MAC O VESTED O NOT VESTED O FRONT FOOTAGE O OTHER SUBJECT PROPERTY PIDN 33�570-/105� �- OCLsO __ II Is the Intent of this development for analysis to put the developer/owner on notice,th.t the fees quoted below mar be applicable to the s hire site spun developmen-of the property. All quoted fees are potential charges that mar be due and payable at the time :onatmRlen Permit Is Issued to Install the on-Ake and off-site Improvements(i.e.underground utliWeaisbeet Impro.:meals,etc.) Tr199�eAnq mechaolsms for the SUCC fees till be based on current Ciry ordinances and determined by the app ioble UtllHy Section. (— ,3 Pleat nett that these fees New sairea to change without notice. Final fees will be based an rates In. rct at time of Railding Permit/Co mbactlee Permit application. The following quoted fees do NOT Include In.pectlan lees,side sewer permits,r/w permit fees or the coal of water meters. SPECIAL ASSESSMENT DISTRICT PARCEL METHOD OF ASSESSMENT ASSESSMENT DISTRICTS NO. NO. ASSESSMENT UNITS OR FEE Latecomer Agreement(put)WATER) — Latecomer Agreement( )WASTEWATER -- { Latecomer A regiment(pvt)OTMER ' $ al Assessment District/WATER — — F fSpecial Assessment Oisbict/WASTEWATER �p I N A moment(METRO) provement DWct Liz)+1� 22 y� Trafficenefit Zones d }/ 0 Z zw ORUGA710N5 TILITY CONNECTION CHARGE•WATER }f,/� 'set/ N OF UNITS/ ° - Irma. O Partial Pd(LU Esem en) Q�Natrar N S .FTC. I ml residential 6 mantle home dwell YR B Conde,a __$SS tit.NCR t n Cemmerclal/Indsstrl .116/sq,fL of property i a) / Ir 1r Nr sera."? / BaelNg.by Special Agmemeot/Fooryrint of Bldg plus IB R parlNmter ' /OAS ,$' / aJ2 2/O.sw am SPECIAL UnL[TY CONNECTION CHARGE-WASTEWATERR _y GKPd Prow. O Partially Pd(Ltd Eaempties) O No, PI M ' / i�RdL..V O/ Sin It itself residential and mobile home dwellin unit 70 mIt a A arbsenp COO40.each muMple:unit$270/ea.waft s c Commerdal/Industrial$.067/14.IL of property s EAHOMOT <".W LITY CONNECTION CHARGE.SURFACEWATER I'd O P.r .I Pal(Ltd Exempt[*.) 5 Never Pat tam residentlat and mobile home dwellingunit$Ad0/malt n opeAles$.1t6/Nq It of New impeMous area of property s"e"? HJ PRELIMINARY TOTAL s f"bled N prop rtysal is wn �xlrl ys .2p plft�.4L[�. r Of wnjed property k within as UII,It Is developers,responsibility to W WM aar���aq...s fins a gip for paid/uropald statu .:/r.,r/e,.a.s�vr".re/rofr Asa EFFECTIVE JULY 1,1392 n/�.1{Y/ s. I X ------------ ►R� TMV jazxi J'��� �y,�► .�Z �- TaNai.Skis aeeela .• "'•- ''r s •i-` !t ��S . . M am too �a ra_-�Ai,4�C�•Tn t ei4A'->TM•;atY•ryypLarn:'7tbr.LiaS1MNEA.WASNINQ'iDNi�D re- 7+DSa+:[s��o.��LraY�y • . tiS1CeC•1nx.f++•l.,#.;sis7c>fenwwr762•s+n"=3•s!0•sli47n r.-��f^.ie,eaiSa`+tM+nti�i t:{ 4 wiY. Ytaw .N'..p: own _T'+ _ •Iw V..�• � .li -.al �..+y � � TI'f•^r::;. t ti 1 G� .�At r•• i• �f)b�$ate:Ys`- �: em• 'AK h"a 0- ' •:y6 '.'oI, var-- -: ��•� 6:»4af :u,a2'nr•T�;k�•nr.Hct e•7•;, r,..�u.�2.•. erm M. ar••�lem ieitL ;;.ieatA•pr 1v.a?ann:i,•!!sa :..: n. rt•"• 2., .. iwa.sf,:y y�Vie: `•� •`. �.Y .. a•e•+ex ft •w•e .M1::".: •ait•'tC^.fa e VAM mass.w• ee ar•yY•eas�eeexebWaF•Iee*r: .. ... .. �a:la' r: .,,."'_ a . . .:• • .w.'. «st. s ea., *.Aottaata .:,,. rh+.Gx • Tt v a..; 'I v A.:, j• . -n,; k•_gter sers+iees FT;M' � t•�sL•,SsO Zd .1••0pppar _. { w•�C.:OlO =6F.aspealt patch imp aaa:a rq:r)4.603.00 t . ...� Y•. ...... ► 4`a• _i . . .. 2:'pais Tins • ifoubl'e detector check w/vault .'•!I! :. •.; .�µp. ,...r, .,,. .•=y 'ea. 6391 Yet tap �::,"'Ifd•F• ,.a.y�••N.•- 8. LF 6" D.2.9. ... -.:.a.,R:a._. - :•. C. 1 ea. riser inside bldg - D. double detector check w/vault a pump - _ taty d ' i. 600 5? asphalt pateb s' :•:n•sc+t e:,:: r�a•e.•�,.:�.�...x sl �. curb a gutter remove a replace G, crushed rock backfill M. electrical for pump lsrp qr IOa7Q,00„ ...sub total '.31,430.00• -plot tales tax, permits a bonds ' owner t0 purchase bonds a permits - , .connection to existing sprinkler system by others -. I t $e �rayaes Mnbyrolum4hm•tsndsndlsbor—oon�yuU:.rmdanoswnnepoa,p•ctlk�ny,if„0,esuma thirty one thousand four hundred thirty a CO a is t•MM b O•Me�a�YMti,� mat loth of •onih - sw+e• _ _ WE WILL NOT ALLOW ANY aeeiebee .. , RETROACTIVE aACKCNAROt:Y `' UNDER ANY CIRCUMSTANCES :mow"tirsM..�.,r, ew•arvaw Arreptanrr nt mawy aeatM4w%a0w.w.s,uvI. ,yrw• Lt,,, wmiw.».n.YY.narw..w.q.ee.wa.Ms.e+.Mn sw 0 n 1 New ir0P0.E.Y� HS;i 1.IV L-� y 2 N L $oNEs AVE- NEPACIFIC WATER WORKS SUPPLY CO., INC. w 21 O y 2Y0o FIRST AVE.SOUTH SEATTLE,WASH.W134 BACKFLOW PREVENTION DEVICE TEST AND MAINTENANCE REPORT 'Aanys, ?r�P.ry��t 'TIS 6eylsynn Avg G4-t-//- 1 LE NO. FIRM NAME l. 6 9/SOA UON ADDRESSylek _?OAGSAL NE. CITYXjf, STATEy __ap. 'IIPOsp PARTY CONTACTED.JgK hAyf REDUCED PRESSURE BACKFLOW DEVICE G PHONE �-6 I I DOUBLE DETECTOR CHECK K - - - DOUBLE CHECK VALVE ASSEMBLY ❑ PRESSURE VACUUM BREAKER ❑ MAKE OF DEVICE 4 S MODEL_7&! SERIAL NO 0'L�7 Y� � slzE 6 DATE INSTALLED s 3 METER NO SlA�/ METEREly-PA METER S READING LINE PRESSURE ,qt) PSI PRESSURE DROP ACROSS FIRST CHECK VALVE PSI Lk CATION OF DEVICE fI ItA,R wAi f 4---/k m 4.4Af fide pff L re _ TEST CHECK VALVE ND. t CNECIL VALVE NO.9 DIFFERENTIAL BEFORE ___ PRESSURE RELIEF VALVE' REPAIRS LEAKED ❑ LEAKED rJ OPENED AT -__PSI CLOSED TIGHT CLOSED TIGHT REDUCED PRESSURE PART CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE NEW L_i I-_ Li ❑ ❑ ❑ PARTS ❑ ❑ Ll ❑ ❑ ❑ AND O ❑ ❑ LJ ❑ ❑ ❑ ❑ ❑ ❑ MARK �`1✓ 1Jt! /A' �is H JUN 3 1993 _-- _ HENTON AFTL1 EDBIPB FID ER CLOSED TIGHT CLOSED TIGHT OPENED AT _p� REPAIRS REDUCED PRESSURE 'REOUIRED ONLY ON REDUCED PRESSURE BACKFLOW DEVICE j RETURN REPORT TO s /-WrFIC TESTED BY /1/YIY _ DATE 'i/•i"TER REPAIRED BY7T-'-'!'; __.—__ LA w DATE V RraR w ,. KS FINAL TEST 9Y J*T'E q M 7 �*L w? TESTER'S WASHINGTON STATE CERTIFICATIONmNOJ.IYJ WWTECtAST(AIEq Rl `EPCE CA YRE"l EILE � ' � 4'7'�. 1+„ !4:, . ..+:� r,ra�i•`�� s'�`n�t „�,'' ' I -�' I � it I 1 i of � �rtrvw•#Y6'6MnrV+'FS'tVlT.i%1t )1.iR � - � 1114L SoNE-5 AVE NP_ PACIFIC WATER WORKS SUPPLY CO., INC. P FIRST AVE SWTH SEATTLE.WASH.99194 t SACKFLOW PREVENTION DEVICE TEST AND MAINTENANCE REPORT __LL// Q Al ` F __ FIRM NAME TA ?Pb Ot rS �Y Di D�SO•I ( Oil S /� ADDRE'_ i y3o t S VG CITY �w l�Ow STATE W a ZIP. 4g Ds6 PARTY CONtT�ACTED REDUCED PRESSURE BACKFLOW DEVICE 1 1 PHONE 1 G a 6�6I DOUBLE DETECTOR CHECK i DOUBT E CHECK VALVE ASSEMBLY 607091 PRESSURE VACUUM BREEA�K�E/R� _ MAKE OF DEVICE gL LL.MODEL 1/f SERIAL NO. TT/i_SIZE Jam_ DATE INSTALLED :Shp 3 _METER NO.7_(L+_L.— METER READING LINE PRESSURE _W PSI PRESSURE DROP ACROSS FIRST CHECK VALVE __—PSI LOCATION OF DEVICE _Tr bfu if Ai&gl 404//l✓ On "S}' a�G�&A ,S _ r TEST CHECK VALVE NO.T CHECK VALVE NO.p DIFFERENTIAL PRESSURE RELIEF VALVE' BEFORE REPAIRS LEAKED U LEAKED OPENED A7 _PSI CLOSED TIGHT CLOSED TIGHT A REDUCED PRESSURE PART CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE NEW ❑ L ❑ lu PARTS ❑ ❑ U 11 L l�� ❑ ❑ v ❑ ❑ AND ❑ ❑ = �� 31993 ❑ ❑ JU REPAIRS ❑ ❑ I. . . ❑ ElOF CITY OF I.._ n:pl. � MARKS: � •,^nJ ' , YDf:VA _ -_ __ �i TEST CLOSED TIGHT CLOSED TIGHT U OPENED AT PSI 1' REPAIRS REDUCED PRESSURE f RETER PAIRS i 'REQUIRED ONLY ON REDUCED PRESSURE BACKFLOW DEVICE RETURN REPORT TO y^'y��-`� ���.`--^,��"�� 'Ohl TESTED BY �__�� GATE 6 � q3 N' T [/ REPAIRED BY __ __ ___ __ DATE _ VI�RKS FINAL TEST BY _ 8B TE ._ swwy TESTER'S WASHINGTON STATE CERPFICAYRA NO !�p�� ;_y WMTFGUS1tYAER NM(,FiIC[ CANARYA90pIT ru 1 Lsucks TNHnq Lsborstorlas,Inc. SOS Mammy Se ftl WA!15 WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION.READ VGjfA[.TIoWoN SMX OF GOLOofW Caw E hwYNOMRr w as r.b.K"wlpbvdII w wj a i R f%SIEmo THE C"I NAL1E j Mna m rr.a I ;06 ag w ❑FM k,.,k mEOFOnTEM rnaasmOtmwnc--O MOM11 Maar1 IA to. / B O L 4D@ - MAMEOFSnTEM - TssswPLFaaTEclro 6"D1xvAA, owl I .?2T-]6V4 ��INLaMi 1B10MiW01L:Miw) n, L.�CTAr• .T r Qs.L yCe ' SOIIIICE mf �ONOIRIDEAnEll y1p11 r��Ip�E�gpUEkO[Ory�II�L • �SOIIEACE ®YE Ell Fp1ELD ��� ❑NIEMIE � ❑yM1�11� %1 EETOIIlROIIf IC iMM rM MMMAYr�MN>�— "" �;. TYIE OF SAMPLE M tlEAME i �O MOI�i WARA ��^"�OMrARr_tn11_Eny �',�� ' of C.I tME..Na a on. [�IIEPEA19A1M1E nrwnmw.wrap Lrer { L]MW SOUROE WATER ` *T EE BEMMO � �MFw CONSTRVCTUNwRUMMN TYWMrw OTHER(SFMy1 :. tuu MEE ORnEI.Eakk trnsll swrLw ❑uNUTgF.cmTW,oaMMI.EI..M - I Tsan=a earw.+ }�e'�7TLorraa ❑�� j �• C]EEFMFwE w L,f ftw . OMkut1011hpkrlwn —. TOTALCOlMdi4 E mu X mm FECAL C0.n'Owl_ T AN SrARE NOT RSTFO EEGU lE E EEUU9F C]swrL„m El C17), mLlrow.. ❑ - Enp;�OF REN nM.esrM SLiN wN SUE OF QFM TUN "�M UNW(I"R, MflLwm RWE ftM w MR WORD I uMAUTaIW ..YM aMM�a1M�M W Atl u ;