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cvt•rt•tt <br />City of Everett <br />Engineering & Community Scivw(n <br />Sewer Application and Permit <br />NO. 22687 DATE <br />Service Address-1-0 a , -�. . <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By C.r✓C ,:, t <br />DESCRIPTION: <br />Lot Block <br />Plat <br />CHART NO.�z©-Z�,.Sr <br />2 : a—z <br />� <br />Utility Account No. <br />Permit Fee <br />Connection Charge(s) <br />Total Fee -,--A 2--r 4 <br />Signed_ is%-:•�yk- - <br />Ctntotner <br />Sewer District <br />Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr, <br />Type Permit: )4,,. <br />Remarks: <br />VOL <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />r N, S, E, W. <br />Approved 6plJ•! = , <br />City Engmew <br />Issued By lit- f=2.`F <br />Inspection By <br />Date Inspected �� — �� - <br />NO. (2Gii <br />IW,PI-ClIOFI <br />