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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />N0. 25�64 DATE �p=�� ,, l9iS <br />Service Address__ sOZ3 �....... ��„ <br />BillingAddress_ �Sln �.■t � , <br />City, State, Zip. E�r.relt r 9201 <br />Owner (Mortgagor) <br />Billing Na <br />Connection <br />Addre55— 3Stg p�1z� ��no� <br />Phone 6S2_p�,p� <br />DESCRIPTION: <br />Lot 5 Block q <br />CHART N0. <br />Utility Account No._. 76l62-1 <br />Permit Fee_ 30 <br />Connection Charge(s) T20.00 <br />Total Fee <br />sevaz Daoelopsent ees <br />Ord. 984-83 <br />SFR — $800.00 <br />Signed <br />Customer <br />Sewer <br />Plat _ c�..,.r ,� Monthly Sewer Service <br />Unplatted Description Monthiy Sewer Constr. <br />r....,, e___:.. <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Trunk 270 00 <br />Lateral_ /50.00 <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By <br />ne <br />Issued By s..e r <br />nspectio ✓ ���ilHQVt <br />)ate I nspected �—�� "�6 <br />rvo. 25064 <br />