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CHART NO. <br /> everett <br /> �e� <br /> City of Everett raST�a 5-til B� <br /> Sewer Application and Permit 1-0 <br /> 4/17/01 <br /> ND. 23965 DATE -- <br /> 104 77th Place S.W. 76063-7 <br /> Service Address __ Utility Account No.---- <br /> Billing Address <br /> P.O. Bo= 419 Permit Fee 30.00 <br /> City, State, Zip <br /> Kirkland, We. 90033 Connection Charge ) 110.00 <br /> 30.00 <br /> Sherstad a Williams Total Fee— <br /> Owner (Mortgagors — <br /> Sherstad a Williams Ordinance 1669-00 <br /> Billing Name Area I 221.00 <br /> Same <br /> Connection By------- <br /> Address <br /> y -----Address Signed customer <br /> 827-0494 <br /> Phone <br /> 6 Bond I <br /> DESCRIPTION: Sewer District------- <br /> 4 <br /> istrict _ — — <br /> 4 Block 5. 10 <br /> Lot Monthly Sewer Service_— <br /> Plat Cedar Ridge Estates <br /> Unplatted Description_— _-- Monthly Sewer Constr. <br /> 0.20 110.00 <br /> Trunk — <br /> Type Permit: new Connection <br /> Lateral <br /> Remarks: Abutting Lot Line <br /> N S E W-- <br /> A. <br /> A. R. Theal <br /> Approved By <br /> Cil,E-9,-M <br /> E. Bond <br /> Issued By--- <br /> Inspection <br /> y _Inspection By— <br /> Date lnspected z 3 <br /> SEE SKETCH ATTACHED No. 23965 <br /> INSPECTIO14 <br />