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everetl <br />e <br />City of Everett <br />Sewer ApplicatioR and Permit <br />No. 22901 <br />DATE � }5,�979 <br />Service Address 1503 �rrrnco nr.vo <br />Billing Address 6038 26th Atre. N. S. <br />City, State, Zip ��r��rrr.v 98155 <br />CHART N0.__�1'1 _5'C •�,� <br />�s� c� <br />� �"" � � �S <br />(� <br />Utility Account No. <br />Permit Fee r�tE <br />Connection Charge <br />Owner (Mortgagor) RYR►T71�_c g��� Total <br />Billing Name �'�` � ��E <br />Connection By crnr nx� rvrn�mm <br />Phone <br />DESCRIPTION: <br />Lot �• Q' �e Block <br />Plat �� �IGFITS <br />Unplatted Description <br />Tvoe Permir• <br />Na7E <br />Signeci_ C�^Z'. nP(1�$A&h <br />Cuslomc� <br />SEESKETCH ATTACHED <br />r <br />I <br />ir�sr�ECTior� <br />Sewer <br />Monthly Sewer Servi <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By L. E�IINC <br />City Engineer <br />Issued By L• ��iAtt <br />Inspection By �� �lc*-f� <br />�atelnspected <br />No. 229Q1 <br />