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everett <br />e <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />NO. 21957 DATE <br />ServiceAddress <br />CHART NO. 0i I 2 <br />Utility Account No. <br />kjUp,)E <br />Billing Address Permit Fee <br />City, State, Zip �ti'E_>,`t_ 11" Connection Charge(s) <br />Owner (Mortgagor) 4'Et`t j1 <br />N�iL 1� `� Total Fee �o`0�' <br />Billing Name <br />Connection By <br />Address Signed <::-�t k�G�L'r ' :�' <br />Cwtomur <br />Phone <br />RAP " " . Sewer District <br />DESCRIPTION: Q <br />Lot L -1 Block G. C <br />OCT 9 Monthly Sewer Service_ <br />Plat <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />r <br />Ycc <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Lateral <br />Mttting Lot Line <br />N, S, E. W ft• <br />Approved By r k;-'xW1Ny <br />City Enpinter <br />Issued8y <br />Inspection By � 4 <br />Date Inspected 16 — — 7 7 - <br />N0. <br />