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17 <br />Ieverett <br />� <br />City of E:verett <br />Se�►er A�plicatican and Permit <br />�G386p DATE 1l14�'81 <br />NO. � <br />2531 eoyt <br />Service Address <br />Billing Ac'dress -- — <br />Ciry, State, 7ip_ <br />Owner (Mortgagor) <br />Billing Mame <br />Connection By �:ity of Svocett <br />Phone_ __ – <br />DESCRIPTION: <br />Lot _._ Block_ <br />Plat ____ <br />Unplarr�d Descripticn <br />Type Peimit: rapair <br />CHARTNCI. K �9-2�1�5 <br />��- "_ i `GI-';� <br />'�G��� <br />Utiliry Account �Vo._ <br />vone <br />Permit Fee <br />Connection Chargelsl— <br />none <br />Total Fee _ <br />Don Miller <br />_ Signed _ <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />INSPECTIQtJ <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, �V <br />Approved B <br />Issued B <br />H. B�uahep <br />City EnQ�neer <br />E. eand <br />t. <br />//�,�-�� <br />Inspection By���� � ^ � <br />Datelnspec:ed �– � y � �f _ <br />No. 23865 <br />