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everett <br />,� <br />�;ity of Everett <br />S�ewer Application and Permit <br />zi�9i� <br />��0. 23502 DATE <br />3g3o <br />Service Address �0 �=�l ��n° ` <br />Billin�� Address <br />City, State, Zip_ <br />Owner IMortgagor) <br />Billing �'ame <br />City of Ewrett <br />Connection By <br />Addi ess <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Unplatted Description <br />CHART NO...�'� �'O –2 9 –S — <br />Utility Account No. <br />noas <br />Permit Fee <br />Connection Charge(s) <br />none <br />Total Fee — <br />Don Miller <br />Signed <br />Sewer District <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />INSPEC710N <br />Abutting Lo[ Line <br />N,S,E,W <br />Approved By EYXFilEB A. Warren <br />CitV Engineer <br />E. IIond <br />Issued By <br />i / . /., , �-'t�' <br />Inspection By <br />Date l nspected - � % �' <br />No. 235�2 <br />