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everett <br />� <br />Cir/ of Everett <br />Sewer Application and Permit <br />No. 23628 <br />DATE � / 3 D <br />CHART N0. � � � �8 � � <br />j�6ST�D � - Z� �S� <br />Service Address_(n Z Z� � Fi/Ff' G�' Utility Account No. _ <br />Billin Address oX -5'� <br />Y: 9 �� — Permit Fee Z <br />L : N,v .Na p w <br />City,State, Zip-=�=� - , -.-� --,� �fl���i Connection Charge�s) <br />Owner (Mort a or) �1t� J�'C /?.t1fP�v � !-� �co C. � <br />9 9 �_ �� Total Fee Z� <br />Billing Name �-n �/(�i' �'/Y�li�.l� f�' ,���G <br />Connection <br />Phone 77 T—��?` <br />DESCRIPT� � N: <br />Lot � Block � <br />Plat �,,.c jl��� � lf/LC.S Di v.-,r�7� <br />Unplatted Descnption <br />Type Permit: <br />Signed - — <br />Custoncr <br />SEE SKETCH ATl.1CHED <br />INSPECTION <br />Sewer D <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Ciry Engincer <br />Issued By---��'����'� - <br />Inspection Rv � �� <br />Date I nspected � %U � � <br />NO. G��LS <br />