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CITY OF EVERETT <br />UTILITIES <br />PERMIT <br />Date: OS/29/96 CMWO $: <br />Service Addreee: 212 DORN AVE <br />Billing Name: DORRAH LOREN <br />Hilling Addrees: 2820B LINCOLN WY <br />City, State, Zip: LYNN700D6700 WA 98036 <br />Phone: <br />Legal Deecription: Frontage;elk 0 Addn: SNoR ofLUnitec95 Z <br />�C <br />�..�.1}�. I � - � �C({C <br />Change Request' <br />WATER SERVICE <br />S.O. No. 8933 Application No. 30476 <br />Fixed: Y Deposit: <br />Svc. Size: 1 Svc. Type: MA <br />Setter Inetallation Date BY <br />Meter No. _ Size Br <br />Mr.ter Inetallation Date 8 <br />Water On Off_ Locked Out_ <br />Remarks:— <br />TSG <br />ey <br />SEWER SERVICE <br />ermi o.: <br />Permit Type: NEW CONNECTION LID No.: <br />Systeme Development Feee: <br />Water <br />Sewer <br />Bond III Connection ChargeTrunk <br />Lateral <br />Remarks: <br />Inspected <br />Water Permit Fee: <br />Sewer Permit Fee: <br />$701.00 <br />$1�183.00 TOTAL: <br />5330.00 <br />$395.00 TOTAL: <br />�� � <br />Date� ' <br />� � D Grand Total: <br />„�,,;Y 3 01996 <br />$750.00 <br />$70.00 <br />$1,884.00 <br />$725.00 <br />$3429.00 <br />. .................. <br />C17Y OF EVERETT public Worke copy <br />Building Division <br />