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evereH <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />No. 21.954 DATE 91217-7 _ <br />Service Address e-Ct(--4 1-,r-,G=(`.� <br />Billing Address �^�� 4 fi�(-'0-t--, <br />CHART IJO.Q%D 29- S <br />�oS/-ar't5l O <br />Utility Account No <br />Permit Fee_ Q✓ t -) <br />City, State, Zip L ^ VIP-- S Connection Charge(s) <br />Owner (Mortgagor)�Total Fee 1--4 UN—) <br />Billing Name <br />Connection By <br />Signed I I--40I%11PnQA ) <br />Cmt&mr <br />Phone <br />DESCRIPTION: Sewer District <br />Lot - . i - L t Block <br />Plat _- VLF 4- Y * Monthly Sewer Service <br />Unplatted Description_ Monthly Sewer Constr. <br />Type Permit:f�� <br />Remarks: <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Trunk <br />ng Lot Line <br />N, S, E, W <br />Approved By L I- I t- y <br />City Eng.neer i <br />Issues By L c- I �]s <br />Inspection ByT!/ <br />Date Inspected <br />i r <br />