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everett <br />Le---o <br />City of Everett <br />Sewer Application and Permit <br />No.23343 DATE <br />Service Address <br />Billing Address ice' �z-�6{�2 <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By �0 <br />CHART NO. E_y—'S <br />Utility Account No. <br />Permit Fee 4 <br />Connection Charge(s) <br />Total Fee a4 — <br />Signed <br />Customer <br />Phone ��� �744� <br />DESCRIPTION: Sewer District <br />Lot Block Monthly Sewer Service. <br />Plat <br />Unplatted Description Monthly Sewer Constr. <br />Tvne Permit: <br />Remarks: j�� ��p w t-- <br />t-'ovZ i I�SQ <br />(�CGUJ>IC D <br />10-8� <br />j 6 N <br />4 <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />City Engineer O <br />Issued By kQ�L <br />Inspection <br />Date I <br />r,o. 23343 <br />