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everett <br />e <br />City of Everett <br />-Sewer Application and Permit' <br />uo. 25©99 <br />DATE tla7 1, 1995 <br />CHART NO. <br />3/-?16 <br />Service Address <br />3016 leitacal <br />Utility Account No. <br />Billing Address <br />P.O. 1ea 1962 <br />Permit Fee 10•00 <br />City, State, Zip_ <br />9"Waft, we. 9e206 <br />Connection Charge(s) <br />Owner (Mortgagor) <br />Oee*i n r• W1100 <br />Total Fee 30.00 <br />Billing Name <br />Ordlaeooe 984-83 <br />200.00 <br />Connection By <br />Address <br />Signed <br />Custor .r <br />Phone <br />GS3-1042 <br />DESCRIPTION: <br />Sewer District <br />Lot <br />Block <br />Monthly Sewer Service <br />Plat <br />Unplatted Description <br />fte=oel 30 29 S <br />Monthly Sewer Constr. <br />Tvoe Permit: ■M Cbaeectica <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Abutting Lot Line rortDe" <br />N, S, E, W_.__ <br />Approved By A. R. 'Pheal <br />City Engineer <br />Issued By. R. Bond <br />Inspectio Ry— <br />Date Inspected -3 -(PL <br />NO. 25099 <br />