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everett <br />� <br />City of Everett <br />Se�nrer Application amd Permit <br />No. 23124 OATE -��''i .`,��, <br />Service Address Y%��/'= � `�_.- j'/" <br />Billing Address / <br />City, State, Zip <br />Owner (iVlortgagor) ' ' � / <br />Billing Name <br />Connection By �- � ' - - <br />Phone - '� l � / �' <br />DESCRIPTION: <br />Lot � Block <br />Plat ' _ � <br />Unplatted Description <br />Type Permir. . <br />CHARTNO. �{ i3'Z�"Y <br />�� 5 �"� <br />�,� --G - 7 f <br />�� <br />Utility Account No. <br />Permit Fee ���r <br />Connection Charge�s) <br />l'otal Fee � �f <br />Signed — - <br />.., customcr <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />Lateral <br />Abutting Lot Line <br />N,S,E,W <br />Approved By -� <br />Ciry Engineer <br />I SSU2(J <br />Inspection By ��"'�`�-� � � '"� <br />Date I nspected � � � — � / - <br />rvo. 23124 <br />� <br />