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evered <br />� <br />City of Everett <br />Sewer Application and Permit <br />CNART <br /><Su-„f'� Cl<<,f�,��� � 9-uI <br />No. 25943 DATE Oct.29 19�5 � <br />Service Address 141R - 119th DI tF Utility Account No. <br />Billing Address 30?6 Rlhsnp RnaA <br />City, State, Zip Eyerett YA OR10Q <br />Owner (Mortgagor) Toa Herg <br />Billing Name �e�se <br />Connection 8y Sa�ee <br />Address — <br />Phone ��S-?��� <br />DESCRIPTION: <br />Lot r_..��•�— Block <br />Plat <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />IMPORTANTI <br />CALL 1-800-024�5555 48�HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEESKETCH ATTACHED <br />Permit Fee ;p.,�� <br />Connection Chargels) 725:D0 � ' <br />Total Fee 37.00 <br />Spetiel �It111ty Fee fh^d. 1171-95 <br />Mater ��2�4.OD :��.vlv� �Ki�p�N:��z�n t1�1 <br />Sewer 5s39,0� <br />,��4i,�',,_ <br />Signed {�(�� �, . ,�.�,� <br />c,i,�°``S�` '.f.�I.IY� <br />I1�.1��� 7,�.>�.�I(� <br />V; '.F.I;H S 1.'iU <br />Sewer District {;qp�! ISI' 1`+ U!1 <br />Lti�lM115' ?:U.IJ�1 <br />Monthly Sewer Serw{{�yi ' '� - <br />I �f'1.: �l 1. U:':.I;� <br />_ Monthly Sewer ConF��ti��,',, ��� <br />�pUI�F' .ln�l.lhl <br />— Trunk ;4��,�30,'l^ <br />',1_IJ��' S'.fl.l�� <br />L teral �iu 3p5 f1Q �+ �y� <br />11';I ', .CI;.IA� <br />Abutting Lot Linei III l! '�na�):;.li� <br />N, S, E, W_ ft. <br />Approved By s1 Tha.l <br />C�1y Enpmen <br />Issued By ���e_i;ranne� <br />� <br />Inspection By <br />Date Inspected � �'� <br />No. 25943 <br />