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everetl <br />e <br />City of Everett <br />S <br />/tlQ C //- /3 - 7 j I CHART No.- <br />,z.zg,5 <br />Sewer Application and Permit <br />No. 23369 <br />DATE �� � 7 r <br />� <br />Service Address <br />L- A yr <br />Utility Account No. <br />Billing Address 'l- ''-'d-'-'�i.r <br />�Li,t` <br />Permit Fee <br />City, State, Zip ( L41 <br />Connectbn Charge(s) <br />Owner (Mortgagor) <br />1t /`�/C- L,,i_t �ic. <br />" <br />,Total Fee — <br />Billing Name <br />Billing <br />Connection By <br />Address ' /4 4' <br />LL �-Y.'1 =L- L-A-/ i /'�1 '" <br />Signed <br />Customer <br />Phone `> ._:� e< L C <br />DESCRIPTION: <br />Lots Block <br />Plat c, i I,. /' . / i , <br />Unplatted Description <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Sewer District '' & 1d <br />Monthly Sewer S <br />Monthly Sewer Constr. <br />/ -/i_ t.k- �$ i <br />Lateral '! , ;",(j <br />Abutting Lot Line <br />N, S, E, <br />Approved By <br />City Engineer <br />Issued BV / , l`..,, L,r ,� II/I Aj <br />l <br />Inspection By Date Inspected <br />No. 23369 <br />