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CHART <br />everett <br />e, <br />City of Everett <br />tU-3-SO <br />Sewer Application and Permit <br />No. 26423 DATE _Actobaz 71 1987 L— <br />Service Address Utility Account No. <br />Billing Address_ 11201 3rd !� aa_ t <br />City, State, Zip ftMRZftt lO1 98204 <br />Owner (Mortgagor) <br />Billing Name - <br />UM - <br />Connection <br />Phone <br />DESCRIPTION: <br />Lot Block <br />Plat earbor Ridee <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />IMPORTANTI <br />CALL 1-800-424.5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Permit Fee 1n-' <br />Connection Charge(s)�zompt pezDmd 111r1-aR— <br />Total Fee 1e 00 <br />special utility Pre. Ord 1171-BSI <br />water 224.00 <br />Signed <br />Customer <br />Sewer District aced 11 <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Abutting Lot <br />Line1/06 87 <br />5t0jFii tkMIGWA <br />N, S, <br />E, VG <br />ffW1F966 <br />01-Di) <br />€".50 <br />PL116 <br />11:0.00 <br />HECH <br />S1.4.00 <br />Approved By <br />pineer ` <br />t 15.00 <br />Issued By <br />�E�S„�RnC1H <br />Ffat L- <br />4?4.00 <br />{il! <br />160.110 <br />Inspection By <br />Date Inspected <br />26423 <br />No. <br />INSPECTiON <br />