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evereri <br />� <br />City of Everett <br />Sewer Application an� Permit <br />►vo. 23990 <br />DATE � �S/ �� <br />Service Address � .3� � C�(..�.c�. / i!� <br />Billing Address�/�% �-� /� y3 � <br />City, State, Zip -�A ,�_�r++� �/� <br />t� �II aJ'� <br />Owner (Mortgagor) - <br />Billing Name <br />Connection By���.-�,�'� <br />Phone 7�y-�%S�G <br />DESCRI�TION: <br />Lot � Block�_ <br />Plat� � ' _ � <br />Unplatted Description <br />CHART <br />� -� r <br />F7 -_.�' <br />; , '� ' ..' �;� <br />i� <br />_ '. <br />� •.. <br />, ,_ <br />i�;;?,� , <br />� ��, _ I <br />�J <br />Utility Account Na� <br />d� <br />Permit Fee !%d <br />��� <br />Connection Charge(s) <br />�- <br />Total Fee_�� <br />. <br />`:>,.�,� �: �� .. <br />Signed � ��.'_ .i. �� V I <br />Customcr �- -� <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Sewer District <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Trunk <br />Latera <br />Abutting Lot Line <br />N, S, E, W <br />Approved By� • ��G.�� <br />Ciry Engineer <br />Issued By �� `��1" <br />Inspection By � ` <br />Datelnspected v , �UNC � � ' <br />No. 2399� <br />