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AS //..s r e..�..I.t'.Cr <br />n r/ I/ G-/G•7$ <br />evere" <br />,e, <br />City of Everett <br />Engineering & Community Services <br />Sewer Application and Permit <br />No. 22 22 3 DATE .2" '- / <br />LHART NO. <br />Service Address S ' l'4-btility Account No. -3 <br />Billing Address <br />City, State, Zip - -r� %✓� <br />Owner (Mortgagor)-�-f•-=-� ��- 1+Gr .�� <br />Billing Name <br />Permit Feed <br />Connection Chargeis) r�5 <br />Total Fee .> 0 <br />Connection By y' <br />Signed," <br />Address. 1 _ Customer <br />Phone 5 �r <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />Block <br />Sewer District ��— / <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk e r � <br />I <br />Lateral � ' % •f <br />Abutting Lof, Line <br />N,,1E, W 50 ft. <br />Approved By <br />City Engineer <br />Issued By--%'�'- <br />Inspection By C.21/ /-)-'/,O-ff <br />Date InspectedL—y- /;7� <br />NO. 22223 <br />