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eieret: <br />% � <br />City of Everett <br />CHART NO. � r r <br />��,/,� ;.�; .Fj.�S-�/ <br />_ �� <br />v <br />Sewer Application and Permit <br />ry _ Ai�3i�� __ _ � <br />N0. G4055 DAiE --__ --------- <br />920 105th Pleo• 8.�• ��ility Account No. <br />Service Address. ------ -- �0.00 <br />p.0. Bot �19 permit Fee ---- <br />RillinyAddress.—___-- ------ — 330.00 <br />Rizkland, Na. 98037 ��nnection Chargelsl_ <br />City, State, Zip_ --- ---- -- 30.00 <br />Owner (Mortgagor�gh�z�t�d i Mi111a�s _ Total Fee__— --- --- <br />ordinsncs �715-BO <br />Billing Name <br />Sher�t+�d i Milli�e� �_�� � ]39.00 <br />6ar�e <br />Connection By__ — — ' <br />Siyned �' <br />cus�omer <br />Address_-_-- _- --- <br />84Y-019+ <br />Phone__-_-------- - -- 36 Bond III <br />$ewer District_ ___. -- <br />DESCR32TION: 5.10 <br />Lot __ __— Blor,k - Monthly Sewer Service - <br />Plat _ Pis tvoz _ _ <br />Monthly Sewer Constr. <br />Unplatted Oescription_----- ` Z.15 <br />Type Permit: H�v Connecti <br />Remarks: <br />SEESKETCH A7TACHED <br />]30.00 <br />Laterol____ ____— <br />Abutting Lot Line <br />N, S, F, W_ <br />— It <br />A P.. Thoal I <br />Approved By -----' <br />G�y E�g�mmr <br />E. Boae <br />Issued By_— — <br />Inspecuon ny — - <br />�I ' �1�� C;I <br />Date l nspected � � � _, v / . - -�--- <br />No. 240�5 ' <br />�1 7 <br />-i � <br />