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� <br /> CITY OF EVERET7 <br /> UTILITIES <br /> PERMIT <br /> Date: 11/16/98 cMwo �:7lD `I l9 —/ela'-1 - l99891�9 <br /> Service Addreea: 5415 BROADWAY _Change Requeet <br /> Billing Name: JELLISON GARY <br /> Hilling Address: PO 60X 6241 i <br /> City, State, 2ip: LYNNWOOD WA 98036 , <br /> Phone: 425-750-0615 � <br /> Legal Deecription: Lot 0 Blk 0 Addn: LOT A /40-98 I <br /> Frontage: tao. of Unite: 1 i <br /> WATER SERVICE � <br /> 5.0. No. 9963 Application No. 31506 I <br /> Fixed: Y Deposit: t4 <br /> Svc. Sise: 3/4 Svc. Type: SFR 47ater Permit Fee: 5650.00 <br /> Setter Inetallation Date ey_ i <br /> Meter No. ^�l9d�d�`� Size 'S(�$ Hrand'`� ��,�p I <br /> Meter Installation �ate l"> Q� ey " r/ �ryy� <br /> Water On Off Locked Out� By� • ��r,.t,,,,�Q� <br /> Remarka:— �� , D^ y�,�� �c��� G i <br /> SHORT PLAT REQUIREMENT /(/v-��H� ` <br /> TSG L� [ � 4 S �7I ���� ,.Q�_'(.f-F�L -�R��'Q � I <br /> / �/ <br /> SEWEA SERVICE I <br /> ermi o. : <br /> Permit Type: LID No. : <br /> Sewer Permit Fee: $0.�0 <br /> Systems Development Fees: <br /> Water $0.00 <br /> Sewer $0.00 ; <br /> TOTAL: 50.00 <br /> Bond III Connection Charqe: '� <br /> Trunk $0.00 �� <br /> Lateral $0.00 �� <br /> TOTAL: $0.00 <br /> Remarke: <br /> Inepected by Date <br /> Grand Total: $650.00 <br /> Utilitiee Copy <br /> I/5 <br />