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everetl <br />�e <br />� <br />City of Everett <br />! Sewer Application and Permit <br />No. 253n1 <br />I� Service Address_ <br />� Billing Address_ <br />ICity, State, 2ip__ <br />IOwner (Mortgagor�_ <br />I Billing Name.�_ <br />� Connection By_— <br />i <br />DATE __ �= 1S, 1985 <br />]1S 106t]i Pl�w i.:. - — <br />i�oie �stn s..ww r.L. <br />f�1attl�r �• l�15S <br />ll�teo Cyn�t. Iae. <br />36]-0716 <br />Phone_-- — - <br />QES�RIPTION: <br />Lot _ '�-- Block -- <br />Plet _— C�� L� — <br />Unplat.ed Description — <br />Tvoe Permit: 1Nw <br />Remarks: <br />IMPORTANTI <br />CPLL 1-800-024�6556 48�HOURS <br />PRIOR TO OIGGING <br />CpLL 259A811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART <br />ic C.cuA.�7�.e�� • Z/�/g�. <br />Utility Account No _ — <br />Permit Fee ��'�— <br />Connection Charge�s)_— ��'� <br />Total Fee__ �•� --- <br />psdi�no� 1171-eS <br />Nat,�r17�.OG` <br />Signedsw�r�71=�� /'� •� <br />c�„��mo, <br />�enA III <br />$ewer District_—__ -- <br />�.40 <br />Monthly 5ewer Service__�. <br />Monthly Sewer Constr. <br />T�unk ��--�� <br />Abutting Lot Line <br />IV, S, E, W <br />11. R. i'b�yl <br />, APPfOVed dV C��v E��nem -- <br />R. l�rd <br />Issued8y ---�- <br />6 ' <br />ti�C c <br />In,pection By — ' <br />Datelnspr.cted_ ��-z�.--- <br />N� 2530i. <br />�n� <br />h <br />