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everen <br />e <br />City of Everett <br />Sewer Applicotion and Permit <br />"o. 23431 DATE 1? 19_79 <br />Service Address � ��� <br />Billing Address SIS 116th N,E �� Z�l <br />City, State, Zip �11�� M�• 9800� <br />Owner (Mortgagor) r�l Mor!!o <br />9as� <br />8illing Name <br />Co�nection Bv 8� <br />�ss-seso <br />DESCRIPTION: <br />Lot_ 30 31 Block � <br />Plat C11� y�� ��� l�t <br />Unplatted Description_ <br />Type Permit: cap-off <br />Utility Account No. <br />Permit Fee Z•SO <br />Connection Charge(s) <br />2.50 <br />Total Fee_ <br />Signed_ ' <br />Customer <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Sewer District <br />Monthly Sewer Service <br />Monthiy Sewer Constr. <br />Latera <br />Abutting Lot Line <br />N, S, E, W <br />H. M+�ireTt <br />Approved By <br />Ciry Engineer <br />E. Bond <br />Issued Bv <br />nspection B <br />�ate Insaect� <br />"o. 23431 <br />