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CITY OF EVERETT <br /> UTIUTIES � a'0$i'iNG _���AY 21 iq96 <br /> ----.�. <br /> PERMIT <br /> Dat�: 12/28/95 CMWO �; <br /> Servicr. Addrese: 7121 JEFFERSON AVE <br /> Billing Name: BLANK LYLE _Change Requea <br /> Billin Addraea: Po BOX 2266 <br /> Phone;�tate, Zip: EVERETT WA 98203 <br /> 355-4725 <br /> Legal Description: Lot 1 Blk 0 Addn: SP #1202-29-95 <br /> Frontage: No. of Unite; 1 <br /> WATER SERVICE <br /> S.O. tto. 8758 �-- <br /> Application No. 30301 <br /> Fixed: Y Depoeit: N <br /> Svc. Size: 3/4 Svc. Type: SFR <br /> Setter Inetallation Date_— Y Water Permit Fee: $650.00 <br /> B <br /> Meter No. Sixe <br /> Brand <br /> Meter Znetallation Date <br /> By <br /> Water on Locked out — <br /> Remarke:— off_ — By <br /> TSG <br /> —�_ <br /> ermi o, ; SEWER SERVICE <br /> Permit Type: NEW CONNECTION <br /> LID No. : <br /> Sydteme Development Fees: Sewer Permit Fee: <br /> Water $482.00 570.00 <br /> Sewer $814.00 <br /> TOTAL: $1,296.00 <br /> Aond IZI ::o�nection Charge: <br /> Trurik $0.00 <br /> Lateral $0.00 <br /> Remarke: TOTAL: $0.00 <br /> Inepected b� /� � <br /> Date� c` <br /> � <br /> Grand Total: 52016.00 <br /> I� � � � � �/ <br /> I1FC ? 91995 � <br /> Inepector copy <br /> :'i7Y OI" EVERLI l <br /> t .�ii�iirn Division <br />