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ever�,; ,tt <br />� <br />City of Everett <br />Sewer App�iee�t�on and Pe��ni# <br />No. 23995 DATE <br />Service Address <br />Billing Address <br />City, State, Zip — <br />pwner (Mortgagor) <br />i;: ,in,r, :Jame - <br />':onnecF:en Hy <br />� ,; � <br />�.a�ires�_.: <br />� Phunc__ . � <br />C%t3CRl�'1�ON: � <br />�„ , _ Blocl< <br />Plat <br />Unplatted Description <br />9 <br />CHART NO. �– Z' z�'' S <br />:, „���'ED .t��' �-8 / <br />`;I�' , � )L Ff,,��'��E�... <br />, !:;,' <br />� <br />; � - <br />_ Utility Account No._ <br />Permit Fee <br />Connection Chargels) <br />Total Fee <br />_ Signed <br />, <br />Sewer District _ <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Trunk <br />Latera I __ <br />Abutting Lot Line <br />N, S, E, W_ <br />SFE SKETCH RTTACNED <br />INSPECTIOIJ <br />Apprcved By <br />City EnSinecr <br />Issued B <br />Inspection By � - <br />Date l nspected� �`/ �� � <br />No. 2�99� <br />