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CHART NO. <br />everellt <br />e��STE D <br />City of Everett <br />Sewer Application and Permit <br />No. 23678 DATE �/ L <br />Service Address_ - Utility Account No. <br />i <br />Billing Address _ct'�+�• ^ z— — Permit Feel/ 0 <br />v_% <br />City, State, Zip s►e , ' Connection Charge(s) <br />J <br />Owner (Mortgagor)1�X s'/�� Total Fee !Q <br />Billing Name ✓ — <br />Connection B <br />DESCRIPTION <br />Lot I Block <br />Plat ir.Cl/;f lJc/. lY c40e�' <br />Unplatted Description <br />Type <br />SEE SKETCH ATTACHED <br />Signed ' <br />Customer <br />Sewer <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral_ <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved 6y <br />City Engineer <br />Issued <br />Inspection B <br />Date Inspected <br />No. 23678 <br />INSPECTION <br />