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everett <br />e <br />City of Everett <br />Sewer Appiication and Permit <br />No. 23463 <br />Service <br />DATE _ " ��3� � <br />1215 39tU Streot <br />p.p. Dox 30u6 <br />Billing Address <br />City, State, Zip Everett, Ha. 9E1203 <br />Owner (Mortgagor) David A. Brnndvold <br />DaVid A. BrandvOld <br />Bii�ing Name <br />Connection By S� <br />Address_ <br />355-6000 <br />DESCRIPTION: <br />Lot Ptn. 4 Block 1 <br />Plat Hewitt Heights <br />Unplatted Description <br />Tvnr Prrmit: tlaw CARnectlOR <br />CHART N0. T jU - Z� -5 <br />(��st�D g-Z.o$a <br />� <br />Utility Account No. <br />Permit Fee <br />30.00 <br />Connection Chargels) <br />30.00 <br />Total Fee - <br />/ <br />Signed '� <br />� Customer / � <br />,' <br />/� <br />Sewer District <br />Monthly Sewer Service <br />3.00 <br />_ Monthly Sewer �onstr. <br />SEESKETCH ATTACHED <br />Abutting Lot Line horthand <br />N, S, E, W <br />Approved By �'• �'��ren <br />Ciry Enginccr <br />L•. Dond <br />Issued BY <br />Inspection By_ ��-°(1"°� — <br />Date Inspected %i{���� `��"� — <br />No. 23463 <br />IIdSPECTION i � <br />� <br />�� <br />