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CHART NO. S <br />U <br />Fo�sf&P -7 - 31-80 <br />City of Everett r� <br />Sewer Application and Permit <br />No. 23653 DATE 1V-TV/gV L <br />Service Address_7c' "�- 2l2=,a "— ILL?- Utility Account No. <br />Billing Address <br />City, State, Zip��..�.yf <br />Owner (Mortgagor) <br />Billing Name <br />Connection <br />DESCRIPTION: <br />Permit <br />Connection Charge(s) <br />2 si <br />Total Fee <br />Signed <br />Customer <br />Sewer District a /7 <br />Lot _ Block Monthly Sewer Service_ <br />Plat / -2,4: y <br />Unplatted Description Monthly Sewer Constr. <br />Type <br />SEE SKETCH ATTACHED <br />INSPECTION <br />I <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved BYi�(- _� <br />City Engineer <br />Issued By^ r✓ <br />Inspection By --- <br />Date Inspected / <br />ND. 23653 <br />