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ev�•etC <br />e <br />+ City of Everett <br />,.,. ., <br />� ' �; <br />Sewer Application and Permit <br />No. 23462 DATE �. <br />3820 <br />=-�rand <br />Service Address <br />P.O. IIox 3066 <br />Billing Address <br />Everatt, Wa. 9fi203 <br />City, State, Zip <br />Owner (Mortgagor� <br />David A. Brandwld <br />David n. Brandvold <br />Billing Name <br />Dnvid n. 9randwld <br />Connection By <br />P.U. Rox 3066, Everett <br />Address <br />355-G000 <br />DESCRIPTION: <br />Lot ptn 3 Block 1 <br />Plat t2�8L� tiowitt xeiqhts <br />Unplatted Description <br />Tvoe Permit: New Conneetion <br />d <br />CHART NO. �� ?`� `-` � ' <br />i��s-r� �-Z� �o <br />� <br />Utility Account No.. <br />Permit Fee 30.OU <br />Connection Chargel: <br />30.00 <br />Total Fee <br />�` <br />Signed ' / � , �� <br />Customer <br />Sewer District <br />3.80 <br />Monthly Sewer Service_— <br />Mon[hly Sewer Constr. <br />SEESKETCH ATTACHED <br />INSf'LC71C;J <br />Abutting Lot Line piorthend <br />N, S, E, W <br />Fi. �'arren <br />Approved By <br />City Enginecr <br />E. Sond <br />Issued <br />� <br />Inspection By <br />Date inspected �" �.�-CJ-Q-- II <br />rvo. 23462 <br />� <br />ij <br />� <br />�� <br />