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rveretl <br />e <br />City of Everett <br />Sewer Application and Permit <br />NO. 25145 DATE 6/1�/�5 <br />206 9�th Straat 6.8. <br />Service Address <br />Billing Address 1�29 BrwCMq <br />City, State, Zip ��t�' ���0° 98201 <br />Owner (Mortgagor) J � D Baild�rt <br />Billing Name <br />Connection By <br />Address <br />Phone �s�'11G6 <br />DESCRIPTION: <br />Lut �0 Block <br />Plat_=�idq�� Di�. 2I <br />Unplatted Description_ <br />Type Permit: � ��t� <br />CHART <br />;eti;;.,�,.��r _ � s_._ _g, <br />Utility Account No._ <br />Permit Fee �0.00 <br />Connection Chargelsl 3�0.00 <br />Total Fee 30.00 <br />Signed <br />C�rstomrr — <br />SEESKETCH ATTACHED <br />INSf'[CTIOIJ <br />Sewe� )istrict �d I== <br />Monthly Sewer Service 6.50 -- <br />Monthly Sewer Constr. <br />� , 370.00 <br />Lateral <br />Abutting Lot Line <br />N, S, E, W, <br />A. R. Theal <br />Approved By <br />G�v E�pinax <br />E. DOild <br />ISSUC(J BV _ <br />C � �, _ <br />Inspection By � J' _ ��,�r - � <br />` U)atelnspacted_ �-' � Z-� �� � ' <br />No. 25145 <br />