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rverett <br />e <br />City of Everett <br />Sewer Application and Permit <br />NO. Z 1 Z18 DATE dm�:-i5�469 <br />Service Address »� � K--ilya <br />Billing Address �•�+� •�� ��• Cs <br />City, State, Zip apt, ;�33, Ni� 9Yo7� <br />CHART N <br />Sea.�-�- -ru c u�, � NS <br />Utility Account No. <br />Permit Fee 30.00 <br />Connection Charge�s) ��•00 <br />Owner (Mortgagor) +�,�_N.tp�� Total Fee 30.00 <br />Billing <br />Connection By <br />Phone —. <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1-800�424-5555 48-HOURS <br />PRIOR TO D�GGING <br />CALL259-8817 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />�,_ ��_�� <br />ncility D�wlop.iant itie ora. 1171-85 <br />aat�r 179.00 <br />s�wr t71.00 <br />650.00 <br />Signed _ <br />Sewer District �d III <br />Monthly SewerSer ' . -:�R <br />Monthly Sewer Con��`1 � <br />Trunk <br />Glf}C Ew0E.U0 <br />Laterel �CN � i28.50 <br />� �� i �1 <br />E SR(',ft �iS.(l0 <br />Abutting Lot LinefiR�A,Pr f;:'0.�� <br />N, S, E, W���N1nf1iC'ii ft. <br />I�pTF.F' 165!1.00 <br />tilUl7'"2I8 <br />5EIdLlt ;30.[Xl <br />RHDIII Yi'gi.Cd1 <br />AppfOved By `� '� � <br />_ ' .�S . <br />Issued By <br />� <br />� � <br />Inspection By — <br />Date Inspected � � <br />NO. 2721� <br />ir�a�r��c i iori <br />