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T _ _ _ _ . _ . _. <br /> � <br /> � � <br /> � <br /> City of Everett <br /> Se�ver APPlac�tior� and Permit � <br /> NO. 22984 OATE �'/ .; � ' <br /> /7 / <br /> . ,�__ <br /> Service Address -r ; .._ / <br /> � / Utility Account No. <br /> Billing Address �'� (i > ,�- , • ,y� _ <br /> Permit Fee ,✓ — <br /> City,State, Zip_ {� •' <br /> �� v� Connection <br /> Owner (MortgagorJ�'�' � � Charge(s) J <br /> '! J' � ` 'Total Fee J' <br /> Billing Name. ,,,i - <br /> � i <br /> Connection By ' �-/�. „� ' <br /> � <br /> Address /- iJ ;, , ,. , <br /> Signed �' �� <br /> Phone ` j <br /> .,(� / cu:tome, �—�_ <br /> DESCRIPTION: � <br /> Lot/�-� �/ /�_ glock_�1� Sewer District__ I <br /> Plat <br /> Monthly Sewer Service <br /> Unplatted Description <br /> —��_Monthly Sewer Constr. <br /> TYPe Permit � .' , <br /> Trunk <br /> ----- '✓ ---- <br /> Remarks: Lateral <br /> �----�_ <br /> Abutting Lot Line <br /> N, S, E, W <br /> '__----�.�ft, j ,..-;+- <br /> I <br /> , ' <br /> Approved By� <br /> �v Enp neer `� � <br /> Issued By�_�_r,_ � <br /> � '-------_ <br /> Inspection By <br /> -------_ <br /> Date Inspected <br /> SEE SKETCH ATTqCHED <br /> NO. 22�98� <br /> ' - _ INSPEC7fON <br /> ..._Q,,,.,.,� zsoa�a � <br /> � <br />� '' _ � <br />