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S <br /> CHART NO. <br /> r <br /> relt <br /> e. <br /> City of Everett <br /> Sewer Application and Permit <br /> February 23, 1901 <br /> No. 23911 DATE <br /> 76041-3 <br /> Service Address 106 79th Placa S. C. Utility Account No. <br /> 30.00 <br /> Billing Address 13419 129th Placa N.E. Permit Fee— <br /> Kirkland, We. 98033 Connection Charge(st <br /> 107.50 <br /> 30.010 <br /> even T. Iufor Total Fee <br /> Owner (MortgagoYJt ordinance #669-60 <br /> Billing Name <br /> Same S.F.R. 221.00 <br /> Connection By — ,� y <br /> Address Signed <br /> Cmto r <br /> Phone-021-5401- __ <br /> Sewer District <br /> 6 Bond I <br /> DESCRIPTION: 5.10 <br /> Lot_ 15 Block Monthly Sewer Service <br /> Plat _-----.d&xg4*&n--AJLw4e <br /> Unplatted Description Monthly Sewer Constr. <br /> _ Trunk 0.20 <br /> Type Permit: Now Connection _ <br /> Lateral <br /> Remarks: Abutting Lot Line <br /> N S E W ft. <br /> H. Boushey <br /> Approved By City Engineer <br /> B. Bond <br /> Issued By — <br /> Inspection By <br /> Date Inspected <br /> SEE SKETCH ATTACHED No. 23911 <br /> INSPECTION <br />