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everett <br />� <br />City of E�erett <br />Sewer Application and Permit <br />CHART NO. <br />.3 �.vr r_- t.uo.•�;,,. <br />. � - � �- _ 8 -. <br />NO. 25206 DATE Auau�! 2. 19Q5 �_ <br />Service Address 21P 9�th Btra�! 8.8. Utility Account No._ <br />Billing Address_ 1129 Eroadvay <br />City, State, Zip �ntt, Na. 4p201 <br />Owner (Mortgagor) �A ��' �Q' <br />Billing Name <br />Connection By __ <br />Phone Z52-1166 <br />DESCRIPTION: <br />Lot •+ Block <br />Plet — e..+�.�� M� � <br />Unplatted Description <br />Permit Fee 3a_na <br />Connection Chargels) 3]0.00 <br />Total Fee 30.00 <br />Si <br />Cus�omer <br />Sewer Distr <br />Bond III <br />Monthly Sewer Service- 6.50 <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Trunk ]?0.00 <br />itting Lot Line <br />N,S,E,W <br />roved By 7�. R. rheal <br />city Enpmen <br />sd BY H. Bond <br />ection By� J� <br />Inspected��Z ��S <br />rvo. 25206 <br />ft. <br />