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everefl <br />e <br />Ciry of Everett <br />Sewer Application and Permit <br />N0. 2��76 DATE =syte�b�e 1!, 1!!1 <br />1001 IO�th Plaa• 6.E. <br />Service Address -- ' <br />P.O. Ho: �19 <br />Billing Address <br />Rlrkl�oA, •a. 980)7 <br />City, State, Zip <br />Owner (Mortgagor�sb�=�t�d i Milllau. Iac_ <br />6A�r�t�A i Millia��, Sne. <br />Billing Name <br />ea�• <br />Connection By -- <br />027-0�9♦ <br />DESCRIPTION: <br />Lot 10 Block <br />Plat 1'!r-t��r _ <br />Unplatted Deuription - <br />Type Permit: M�v Cona�atlen <br />Remarks: <br />SEESKETCH ATTACHED <br />CHART NO. �- �`� L"'� <br />� �., � � �, � <br />r r �N 17 • <br />� � <br />76091-] <br />Utility Account No. <br />]0.00 <br />Permit Fee - <br />Connection Chargels) <br />ao.00 <br />Total Fee___ <br />OrAla�aae 715-80 <br />Ar�a 2 7�9.00 <br />Signed c��:�o„�� <br />Sewer Dislrict �b— <br />Monthly Sewer Service_ <br />_ Monthly Sewer Constr. <br />_ _� 2.]5 <br />INSPECTION <br />Lateral <br />eone III � <br />— <br />6.50 <br />]]0.00 � <br />Abutting Lot line <br />N, S, E, W <br />AppruvedBy �• �• Theal <br />Cny Eng�nem <br />E, eone <br />Issued BV <br />it. <br />� �� I <br />Vw�.rS I <br />Inspection By�L� � <br />i <br />Date I nspected_ � z ' C�� � ��J 8� � <br />No. 24076 ' <br />