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everett <br />e <br />City of Everett <br />Sewer Application and Permit <br />No. 23064 DATE ����,� _ <br />Service Address� �� � _ <br />�� . �, <br />/ <br />Billing Address �� <br />City, State, Zip <br />CHART N0._ � l �ZfI-S <br />. 7�o.s?�"J/ <br />s;o��� <br />�� <br />Utility Account No. <br />Perm i t <br />Connection Charge(s) <br />f�wner�Mortgagar) _ _ TotalFee •-'' <br />E3illing Name _ <br />Connection By � �� ���- <br />/ <br />Address � '%� <br />Phone <br />DESCRIPTION: <br />Lot ss Block <br />P!at <br />:' i <br />Signed • J ' <br />Customer <br />Sewer <br />Monthly Sewer <br />Unplatted Description Monthly Sewer Constr. <br />Type Permi? <br />Remarks: <br />� <br />,n�-r�n_.c i._ ,r- / s- �/ ' /!/, �/ //J, r.� <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Abutting Lot Line <br />N, S, E, W, <br />Approvad ay.. �`:"- :// - <br />City Engineer <br />� i' . <br />Issued By — � <br />/ , /� <br />Inspection By : -� ���1 �%� ��.<n-� <br />Date Inspected_�`� ZJ ' 7`1� <br />rvo. ?3064 <br />� <br />