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.� <br />�� <br />City of Everett <br />Sewer Application and Permit <br />N0. 23776 DATE ��� <br />Service Address�� �'!��t� <br />Billing Address a�6 _��.�dd��+�.� <br />City, S� <br />Owner <br />Billing <br />Connec <br />Phone �� � —���� <br />DES R�PTION: <br />Lo� Block <br />Plat ` <br />Unplatted D cription — <br />CHAFTNO.-S �?��y <br />`�'_�l.J W DN\ <br />7�C,�` �J IU-Zl -� 1 <br />��� <br />Utility Account No._—_ <br />O�% <br />Permit Fee 30 — - <br />Connection Charge�sl�_'. — <br />Total Fee •�� �� <br />Signed 1 � . � <br />customer <br />SEESKETCH ATTACHED <br />INSPECTION <br />Sewer District__ <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W_ <br />Approve�i By� `���'�'� <br />Crty Enpineer <br />Issued By� <br />Inspection <br />Datelnspected� � <br />rvo. 23776 <br />