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CITYOFeVERETT ���., P��TINFJ �-Z3 f� I <br /> UTILITIES <br /> RERMIT <br /> Date: 10/13/S•4 CMWO #: <br /> Service Address: 626 40TH PL _Change Re uest <br /> Biliing Name: DALLY H019ES <br /> Billing Address: 3290 EASTLAKE AVE E <br /> City, State, Zip: SEATTLE WA 98102 ' <br /> Phone: 328-3770 <br /> Legal Des�ription: Lot 48 81k 0 Addn: SILVERHAWIC <br /> -- Frontage: No. of Units: 1 I <br /> WATER SERVICE I I <br /> � <br /> S.O. No. 8238 Application No. 29781 <br /> Fixed: Y Deposit: , <br /> Svc. Size: 3/4 Svc. Type: RES Water Permit Fee: $105.00 I <br /> Setter Installation Date gY I� <br /> Meter No. Si2e Brand <br /> Meter Installation Date gy <br /> Water On Off Locked Out By <br /> Remarks:— — — _ <br /> TSG I <br /> SEWER SERVICE '� <br /> Permi.. o. : ' <br /> Permit Type: NEW CONNECTION LID No. : � <br /> Systems De�relopment Fees: Sewer Permit Fee: $70.00 <br /> Water S452.00 <br /> Sewer $761.00 <br /> TOTAL: $1,7.13.00 <br /> 6ond III Connection Charge: <br /> Trunk $0.00 <br /> Lateral $0,00 <br /> TOTAL: $0.00 <br /> Remarks: <br /> Inspected by �j G.'�� �Gldi„ Date /0 - 3 i 5' <br /> . y <br /> Grand Total $1388.00 i <br /> Public Works Copy <br />- - - --- - ,✓�dr^ . �' f ' �r : <br /> � .' �.� �,'r v�,A <br /> �\ r ..+Pr,. <br /> .. „ �� t� . . .r��..��. �`��`� <br /> W � <br /> � __ � ' �.�� •�.� �'i�'�� <br /> , _:. �.r ..om •.: <br /> , ._. .�. .'. <br /> ...._ . :�i . . . . <br /> ._._ _ _. _. . . . . ___. ___ . —_ --. —_. �.._.,._s�.... -.�..._.s_ . . . ii..�a.:Y1:__ <br />