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everett <br />� <br />City of Everett <br />Se�vv�►tl Applicatio�� �and Permit <br />CHART NO. `- �� "Y-`� <br />, .. . ._ :s . . <br />�0 S�� <br />J�'- G % - % g <br />/ - <br />/� <br />N0. 22976'' �j DATE � <br />, <br />ZL?� �/�-��/!1/9� LU!? <br />��..-..�. <br />,�/_r.__.-_-----... _..-__ ..--.`��- -._: <br />Service Address "'- - ' Util�y Account No. <br />—,�G• � L✓`� ';1 �• � /, )� , <br />Biiling Address �=`'�� �/� ah/�L� w Permit Fee ': -- <br />City, State, Zip � -> > - �' � `�' � � Connection Charge(s) <br />Owner (Mortgagor) <br />�!� <br />Connection <br />Total Fee_ - <br />Address Signed __ <br />Customcr <br />Phone <br />DESCRIPTION: Sewer District <br />Lot = _ Block <br />Plat_ � ��'�':�-;�/,-,�?(_���'i'-MonthlySewerService <br />Unplatted Description Monthly Sewer Constr. <br />Tvna Pnrmit• � �' � -�" <br />SEESKETCH ATTACHED <br />INSPECTION <br />Abutting Lot Line <br />N, S, E, W. <br />l,., <br />Approved Bv " <br />City Enpineer <br />Issued By � - _' <br />Inspection 8y _ � � ����� <br />Date I nspected � ^ �� �� - �i _ <br />N0. GZa�� <br />