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everett <br />� <br />City of Everett <br />Sewer Application and Permit <br />No. 250�3 <br />DATE 4�`y�85 <br />Service Addresi9lF '��+p�Rjdh` �"� — <br />Billing Addresss113 23rd Avenue Heot _ <br />City, State, Zi�rett, via. 90203 <br />Owner (Mortg�oiE1 DOp`� yr• <br />Billing Name 5a^t` <br />Connection <br />Phone 355-1850 <br />DESCRIPTION: <br />Lot 3 Block <br />Plac � p u�� Q'+ <br />Unplatted Description <br />Utility Account No. 16305-5 <br />Permit Fee 30 Op <br />Connection Charge�s) 600.00 <br />Total Fee 30,00 <br />, <br />( !'./ <br />Siyned ''''r �%';��= . -- <br />Customer <br />Sewer <br />$ond I <br />Monthly Sewer Service � red <br />Monthly Sewer Constr. <br />Trunk____ <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, W_ <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Approved By A• F• Tl�eal <br />City Enginccr <br />Issued BY E. Dond <br />/� <br />Inspection By ��V��P�"'-` — <br />Datelnspected S'j'�� — <br />No. 25093 <br />� <br />n <br />� <br />