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everen <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 23543 <br />Service <br />Billing <br />City, S' <br />Owner <br />Billing <br />Connec <br />DATE � - �-� �- � � — <br />Address <br />Phone �a �— ��/� <br />DESCRIPTION: <br />Lot ,�/ - � "-�- Block� <br />� <br />Plat — Y. --= �_ <br />Unplatted Description <br />CHART N0. N �'-?-�-� <br />P��rc� a 2i-� <br />Utility Account No. <br />� 5� <br />Permit Fee �-`_ <br />Connection Charge( <br />S� <br />Total Fee ��� � <br />Siyned <br />Customer <br />SEESKETCH ATTACHED <br />INSPECTION <br />Sewcr District <br />Monthly Sewer Serv <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N,S,E,W, <br />Approved B <br />c�iv <br />I ssued <br />�� <br />j/ � <br />Inspection By— C,�;/+�-.— <br />C' <br />Datelnspected��7 �<1�-`� CJ�L <br />rvo. 23643 <br />