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�t <br /> r ' <br /> CHART N0. <br /> everett <br /> e <br /> � <br /> City of Eveiett <br /> Sewer Application oe�d Permit <br /> N0. 25070 DATE //9�.Qy _ <br /> Service Address_�� ,� Utiliry Account No. <br /> i 00 ' <br /> 9illing Address�Ja Permit Fee �0 <br /> City, State, Zip /ai • � 7�/.[' `�' ao ` Connection Charge(s) <br /> � a� <br /> Owner (Mortgagor)� ' � Total Fee � <br /> Billing Name <br /> Connection By (��+x�� ` �e�rre-- <br /> Address �yQ� �6� 1�• Signed <br /> ��P�� 3 Cus�omer <br /> Phone y3�- y'ya�" <br /> DESCRIPTION: Sewer District <br /> Lot� ' 3� Bloc � 3 <br /> Monthly Sewer Service <br /> Plat !.+�" ' L_ <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: (� " .� <br /> � Lateral _ <br /> !�emarks: <br /> Abutting Lot Line <br /> N� g� E, W fL � <br /> Approved B'i�d • � �� <br /> Ci y Engineer <br /> � <br /> ISSU@d By V ' `../rl->Z-� <br /> � ���/,� <br /> �, Inspection By � <br /> Date Inspected �' Z � '�� <br /> SEE SKETCH ATTACHED NO. 25Q�Q <br /> INSPECTION J <br /> t._ - <br />